New here - should I start treatment? Help with moody cat

I was lucky enough to have a very thoughtful and caring vet who pointed me in the direction of this message board after learning his diagnosis. After reading the FAQ and a few posts, I am feeling overwhelmed and not even sure if I should start on treatment or if it's in my Loki's best interest to put him down.

Loki (12 years) has never been a very social cat. He doesn't like attention from strangers and for the most part, just wants to be left alone. He'd often claw at guests in the house and need to be removed. That being said, My relationship with him has been long and rewarding and It would break my heart if I lost him.

I mention Loki's disposition to people because about two years or so ago, he started developing mood swing that were more violent than usual. They got so bad that my partner was reluctant to be in the house alone with the cat as it would attack randomly and unprovoked. We of course took him into the vet who said that he was perfectly healthy and that his issues were mental rather than physical. he suggested an antidepressant. We tried to keep it up, first with the pills, then with a liquid version - both were unsuccessful, as he became anxious and fearful of pill time and eventually food time, and seemed miserable all the time. After about three months of this, We decided we couldn't continue the regiment. It wasn't the quality of life that he deserved to have and the medication wasn't a solution. We expected to make a vet visit in the near future to have him put down, but in the coming days and then weeks, we noticed no violent episodes and his behaviour eventually improved to the point where I would say, it was better than it ever used to be. We couldn't believe it and thanked our lucky stars that it turned out this way.

About a month ago I started observing more frequent urination, and also some strange meowing while he was eating. I brought him to the vet who took a look at his mouth to reveal some teeth that need to be pulled. In preparation she did a blood test to see if there was anything else we should be concerned with and to our shock and dismay, Loki's results showed that he was diabetic. Our vet advised us that we could treat the condition with insulin which would need to be administered every 12 hours. In addition, we'd have to test him on a regular basis.

After we got home from the vet, Loki vomited for about 2 days largely in part to the stressful experience of kennelling to go to the vet and the 40 minutes travel time to get to the veterinary clinic.

After two days, he seems to be back to his happy self, and we've started on his wet diet, which he's adjusting to well.

We haven't started the insulin treatments yet and I'm scared that we'll have the same experience as we did trying to medicate him for his violent outbursts. My fear with giving him the insulin injections and required tests is that he will go back to being lethargic and scared of any sort of human interaction. The last thing I want is for him to be living in fear again.

What is the humane thing to do here? Is it possible that diet alone could do the trick? I'm worried that my only solution is euthanasia. Has anyone had a similar experience?

 

Changing from high carb kibble to allow carb wet is a great first step. You can test the bg at home without ever needing to bring him to the vet for testing, but I strongly encourage you to get the dental done. Infection and pain as well as vet stress can raise bg levels hundreds of points. Which food specifically are you feeding? Well your cat let you touch his ears? Maybe try desensitizing him to having his ears touched so you can eventually test them. Insulin shots can be given while he eats. Get a very thin syringe and he will probably barely feel it.

I have a"crazy " cat who we thought we would have to put back outside (we found her as a stray) or rehome. She viciously stalked and attacked my father in law for weeks (they had taken her but Gave her back because of the attacks) and once sent me to the er. 5 lbs of fury. We were especially concerned because at the time my partner was pregnant with my son and we were worried for the baby. We talked about trying her on Prozac and the vet suggested we try Feliway first. It made a huge difference and we didn't need the medication. We have 3 of the diffusers around the house. At all times. We can always tell when one of them runs out because she becomes anxious and hyper reactive to everything. BTW she gets along great with my son who is now 5. So if you haven't tried it, it may be worth a try. I don't think all cats respond to it, but lucky for us Julie does.

 

Sounds like you have a great vet! Like Janet said, try the feliway and start getting Loki used to being touched and rubbed on the ears and the scruff area for testing and shots. When you start testing, do it when he’s in a calm mood, not hungry or stressed. You also need to be calm because he can sense if you’re nervous. To help with your nerves, be sure your familiar with the test equipment and try singing softly, many swear by that.

 

Did you go ahead with the dental, or is the vet waiting until the diabetes is stabilized? Dental pain can really stress a cat out and affect blood glucose, so if it's possible to get the procedure done first, I'd do it. It likely won't resolve the diabetes, but it will make dealing with the diabetes much easier, and he'd have a better chance of getting stabilized or even possibly going into remission. It might also improve his mood-- has he ever had a dental before? I ask because some problems can cause a lot of pain while hiding below the gumline, so if he hasn't had a cleaning with x-rays recently, hidden problems might even partially explain his change in behavior in the last two years.

 

*** ALERT: LONG POST ***


Hello and welcome to you and Loki.

Quite a lot you're dealing with here. Your options:

1. Try the diet change for a week or so. Do it slowly to avoid digestive upsets. During this time:

- Measure the amount of water and food your cat consumes each day and record it in a daily journal.

- Keep brief notes in your daily journal about any changes in clinical signs (appetite; urine output; mood; coat condition; energy levels; ability to jump to sofa/windowsills/bed).

The daily journal will be an invaluable aid to you and your vet when making further treatment decisions.

2. - Monitor daily for ketones! Because Loki is not yet receiving any insulin and undergoing a diet change it is an especially important precaution to test urine daily for ketones and, while not home testing BG, it would provide helpful diagnostic information to check for glucose as well. Use human reagent strips like Keto-diastix which have panels for both glucose and ketones. Some cats can end up in DKA (diabetic ketoacidosis - a potentially life-threatening complication of diabetes requiring emergency hospital treatment) before they even get a chance to receive any insulin. More info here:

Importance of testing your cat for ketones

Tips for collecting urine samples

At the very minimum if your kitty becomes more noticeably lethargic, starts going off food or parking himself beside his water bowl test for ketones straight away, either at home or at the vet (nausea can be a hallmark symptom of DKA). Both ketosis and DKA are medical emergencies and the cat needs to be taken to the vet for treatment immediately, day or night.

3. If you can manage to learn to home test blood glucose levels ASAP and Loki will accept it, monitor BG levels during the diet change (after fasting for 2 hours, and also about 2 hours after a meal).

4. After the diet change has been completed, test urine and blood glucose levels again and, if you have not been able to monitor BG levels at home ask the vet to check BG and run another fructosamine test to get a picture of average BG levels over the previous couple of weeks. Note: BG readings at the vets may be stress-influenced. If you bring a urine sample with you then if that tests positive for glucose it means that in the hours since the previous pee the cat has spent at least some of that period with a BG level higher than the renal threshold (the point where glucose starts spilling over into the urine). A glucose positive urine test will not have been influenced by vet stress and, while a very crude indicator, it will provide some further evidence that the cat is an unregulated diabetic (and therefore in need of insulin).

ETA: You also need to monitor Loki's weight (at home or at vet check-ups). If he is eating well (or more than well) and losing weight then again that is a pointer to his needing insulin to control his diabetes. (Uncontrolled diabetics tend to lose weight because, since not enough glucose can get into its cells, the body cannot properly utilise the food that's being consumed.)

5. Assuming you go for insulin treatment you may find that Loki's fairly OK with the injections (they're certainly easier than pilling a cat!). If he is a bit reluctant at first, you could try a programme of desensitization and counter-conditioning to help Loki better accept the injections. Here's a really good video tutorial:



6. 'Last Chance Saloon' Treatment

If it should prove impossible to treat Loki with insulin, there is one other potential treatment avenue: oral hypoglycaemic medications (e.g. glipizide). The 2010 AAHA Diabetes Management Guidelines for Dogs and Cats advises that oral hypoglycaemics are only indicated where insulin therapy is not an option and euthanasia is the only other alternative. The guidelines also state that "these agents are not considered appropriate for long-term use." According to Vetbook, many cats are not suitable candidates for treatment with oral hypoglycaemics and treatment outcomes for cats on these types of medications are mixed to poor. Some of the drugs used force an already taxed pancreas to produce more insulin, creating further beta cell damage and decreasing chances of diabetic remission. More information here:

Petdiabeteswikia - Oral Hypoglycaemics

Vetbook - Oral Hypoglycaemics

Petdiabeteswikia - Remission

Bearing in mind your observations above on how difficult Loki has been to pill in the past, you may find insulin injections much, much easier to give than trying to administer drugs orally to try to control his diabetes.

If it proves that diet change alone does not control Loki's diabetes, the very best suggestion I can offer is that you at least try the insulin treatment. I've seen many cats here surprise their humans by fairly quickly learning to accept the insulin injections and ear pokes (and we can give you lots of hints 'n' tips to help!). Cats are smart and they don't take very long to work out that all the poking and prodding is directly related to their feeling much better as their BG regulation improves. (Come to that, I've also seen humans here surprising themselves by managing to overcome their own fear of needles in order to help their kitties!) I know that you're worried about how the jabs and pokes might affect your relationship with Loki. Many caregivers of diabetic cats report how looking after their kitties' diabetic needs actually strengthens the bond between them and brings cat and human closer to each other.

Assuming that you can successfully transition Loki to low carb wet food and give him a bit of insulin support, if you start treatment with a long-lasting insulin (Lantus, Levemir or Prozinc) then with a good home testing routine you will increase his chances of achieving remission (becoming a diet-controlled diabetic without the need for daily insulin treatment). Some kitties achieve remission with diet change and a fairly short period of insulin therapy; some go on to lead full and happy lives as insulin-dependent diabetics.

If you find that Loki will take the injections but ultimately won't tolerate home blood glucose testing, you can use secondary home monitoring techniques (e.g: food and water consumption; regular urine testing for glucose and ketones) plus regular BG curves/fructosamine tests at the vets to manage his dosing and overall treatment plan.

In situations where home BG testing proves unfeasible it is not safe to attempt to tightly regulate a cat so treatment focus shifts away from greatest optimisation of BG levels towards minimisation of hypoglycaemia risk - and the price paid is typically to keep the cat running at somewhat higher BG levels than those whose BG can be regularly monitored at home. (Safety note: Even if not home testing regularly it is highly advisable to keep a glucometer and test strips at home, if only to check a cat's BG level in a potential emergency situation.)

While FDMB strongly advocates home BG testing as the best way to keep a diabetic cat receiving insulin safe and as well-regulated as possible (it is!) the truth is that there are an awful lot of diabetic cats and dogs out there in the world who muddle along on insulin with only their water consumption being monitored plus periodic vet checks, not least of all because some vets actively (and wrongly) advocate against home BG monitoring, some to the point of outright hostility. (I had vets like that: they got fired.) When all is said and done, if I were unable to home monitor my cat's BG, I'd sooner have my untested kitty running slightly higher than not have my kitty there at all.

I hope some of the above is helpful to you when considering your treatment options for Loki. Fingers and paws crossed here that, should he need insulin, he will be cool with his injections. The positive changes insulin therapy makes to a diabetic cat's health and happiness can be nothing short of extraordinary!


Mogs
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Thank you to everyone who posted, from the bottom of my heart.
I'm hoping we can find a good solution

 

We're also good at these -----> .

I hope you can find a solution that works. Please, please keep posting with any questions you have - or even if you just need a bit of moral support!

There are members here who have years and years of experience with all aspects of day-to-day care of feline diabetics. We'll do all we can to help and support you and Loki with all manner of practical hints and tips to enable you to develop a routine that really works for the two of you.

Oh, yeah. More hugs ---> .


Mogs
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Another thought on pheremone diffusers:

Feliway recently brought out a new diffuser product called Feliway Friends (mimics 'harmony' pheromones produced by nursing queens). My civvie, Lúnasa got really hyperactive and aggressive after she was initially diagnosed with hyperthyroidism. I found that the Feliway Classic diffuser didn't help much but when I used it in tandem with a Feliway Friends diffuser the combination did help to keep her calmer. FYI: Only myself and herself in the house but she became less aggressive toward me with the diffuser combo in use so I think it might generally help with aggression, not just aggression between felines.

Info on Feliway Friends


Mogs
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Singing works!


Mogs
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