? Lethargy/weakness, bloating, snoring... Better BG #s but still not herself. When to see improvement?

Now that Butterscotch's BG numbers have been trending into mostly yellows and blues over the last couple of weeks I guess I expected her to start acting more normal. She initially improved in that she is no longer hiding under the bed and on most days seems to be drinking and peeing a little bit less (but still a lot), and she started grooming herself again. I have several general questions if anyone has any information that could help me set reasonable expectations for her or to identify and problems/solutions that I may have missed.

She lays on the floor almost exclusively (previously liked to be up on the back of the sofa or seat of the chair etc). She still jumps into our bed early in the morning to make sure we are waking up to get her food and jumps into a window perch (however I put a box below each to create a sort of stair so she can do it in two jumps instead of one). I can't tell if she is just weak and thus prefers the floor but she almost seems depressed. She used to be a lap cat and now when I put her on my lap or on the sofa she jumps down after a few minutes. When she walks she looks weak in her back legs, she takes the stairs more slowly and unsteady. She often stumbles or wobbles while walking more than a couple steps (not related to low BG, I have checked many times.) She appears to walk short distances and then lays down as if to take a break before continuing to walk. Her front feet slip when she sits on the hardwood floor. She used to like to be in the same room as me and would follow me everywhere. Now she almost exclusively hangs out in the dining room away from us. Still enjoys belly rubs and all petting.
She doesn't really play anymore. The only thing I can get her to paw at is a peacock feather. She will only paw at this while laying down. She hasn't played with anything while sitting or standing and won't move around to play with anything for at least a couple of months. Sometimes she won't even hardly look at the feather moving, or when she does play with it she only does for a few minutes.
She has clearly lost a lot of muscles in her hind legs as I used to feel her hearty muscles before and now they are all soft.
She barely notices birds outside or won't look at toys we move around in front of her.
Is this just weakness, or neuropathy, or is she sad/depressed? Is it normal for her to be this sleepy/weak/uninterested in things with diabetes even though her numbers have been better for a couple weeks? Should I expect this to improve?

Several months before her diagnosis I noticed her belly was very hard and bloated. She has never been overweight. I can't tell if the bloating has gotten a little better or if her belly just feels smaller because she lost a couple pounds and is now underweight. Her belly dose still feel tight/firm and often makes a lot of loud gurgley noises. Upon diagnosis they did an xray that did show an ileus but vet didn't explain anything about it and basically won't comment on it at all when asked and says if we want to know any more then we have to pay for an expensive ultrasound which we can't really afford. She also has been scooting on the carpet after bowel movements for a couple years. We used to take her in to have her anal glands expressed but that never seemed to decrease the amount of scooting. A year ago or so we tried to see if pumpkin would help but it also didn't seem to decrease the scooting. She doesn't seem to strain to poo and stool looks formed. She poos usually once per day.
Thoughts on the bloating, ileus and scooting? Are these related to the diabetes? Can I do anything to help with these things?

Several times in the last month when she is laying on her back I can feel her bladder. It feels very full/distended. When I notice her bladder full and I pick her up and put her in her litter box she will usually pee a large amount. She doesn't appear to have trouble peeing. Why would she be holding her bladder like that? Or maybe this is normal and I just never noticed it before.

She still drinks a ton of water and lays in her dish while drinking even though her BG numbers have improved. Is this typical or should I be considering something else that might be making her want to drink so much?

About a year ago maybe, she started making snoring sounds once in a while. Over the last few months it has become increasingly worse. The sounds occur during inspiration and sound like grunty/snorty/snoring/stuffy labored breathing. It sounds like it is mostly coming from her nose/throat area but if I have my hand on her back I can feel the vibration of air in her ribcage like she's working really hard to move air through her lungs. I think maybe it is stridor? It happens only while she is laying down and can be while awake or asleep. It never happens when she is walking or sitting. Sometimes if I pet her she will change her position and the sounds subside or decrease. The sounds have gotten worse to the point that they scare me sometimes and I get her to move around so that a new position might make them stop, which sometimes does work. She never makes the noises at the vet and when they listen to her lungs they always say she is fine. On xray at her diabetes diagnosis the vet said her upper airways looked constricted like that of a much older cat. Could this be related to the diabetes too, or something else?

I think I'm mostly concerned about her weakness and lack of energy or interest in anything. It makes me questions if we are doing the right thing by keeping going with the insulin. Is she depressed, in pain, suffering? She literally just lays on her side sleeping or staring into space all day and that just doesn't seem like quality of life.

Sorry for all the rambling. Hoping someone has had experience with these problems/observations and can shed some light on what might be going on or reassure me that its all typical diabetes stuff that really does take forever to improve.

 

I forgot to mention that several years ago she started occasionally having some twitching. She'd twitch a front paw, or the muscles in her face around her whiskers would twitch. Sometimes she would be laying there completely normal and then suddenly turn and bite/lick at the base of her tail. It was pretty mild and infrequent. I thought maybe it was "twitchy cat syndrome." But she doesn't self mutilate or have sores on her skin or anything which I guess can happen with that. Sometimes her back does ripple too.

Since her diabetes diagnosis the twitching has gotten much worse. Her front and back legs as well as face twitch, maybe even sometimes her tail. It happens very regularly, like if you stare at her for any amount of time you are bound to see her do it at least once. She's been doing little twitches for so long that I just got used to them but now it is all the time. Could the diabetes be making this worse or is this just a coincidence?

 

Oh, I'm so sorry Butterscotch still isn't feeling herself. It can take time-- there are all kinds of reasons why a kitty can still be lethargic even after you get them into good numbers, starting from the fact that they have gotten so used to the bad ones, "good" doesn't feel normal to them any more. Sometimes the ups and downs themselves make them feel "off". If it's just one of these, it will get better as she spends more time in a normal range and gets used to it again. That said, it's wise to be vigilant and concerned-- you don't want to miss anything.

I don't know that I have the expertise to comment on a lot of the symptoms Butterscotch is presenting, but one issue she has that might have an easy (if not particularly fast) solution is her apparent neuropathy. Neuropathy, particularly in the hind legs, is very common in feline diabetics. Fixing it involves getting them into better numbers (which you are doing), and suppplementing with B12. Many people here use a supplement called "Zobaline" (available on Amazon). It's made for diabetic cats, so doesn't have any fillers or sweeteners that would be harmful. It can take a few months of supplementing to see results, but if that is Butterscotch's problem, the B12 supplementing can help a lot.

On the stridor, my diabetic cat does this too. It can, sometimes, be associated with a high-dose condition called acromegaly-- but not always (not for my kitty, for example. It's just the way she is, I guess). In the case of acro cats, the cause is extra tissue growth in the airways. Butterscotch is a long way away from suspecting a condition like acro, but it's worth noting that even though it's termed a "high dose condition", and that's normally when it's tested for, it's possible to be acro and be on a relatively small insulin dose. Again, though, I don't see any strong reason to suspect acro in Butterscotch's case at this point, but you might want to look into the other symptoms to see if anything else matches.

 

Well, that's a lot of different things. I think some of the symptoms you mention could be several different things, so it is hard to know. I would suggest tests to start ruling thing out, but you mentioned cost being an issue, so I don't know if that is really an option for you. Have you had blood work done recently? If so, maybe you could post the results here to see if anyone can offer you any feedback on them. Excessive drinking, urination and weight loss can be symptoms of hyperthyroidism.

As far as leg weakness, if it is neuropathy, you may want to consider something like Zobaline to help with that. (I see that Nan just posted and recommended that as well.) That along with the glucose getting under control and being there for awhile should help.

 

How much time would you consider would be normal to see improvement of symptoms from when BG numbers are better? I know ECID, but is there a point when you'd say, if she isn't feeling better after a couple months, a year etc that maybe it isn't going to get better?
I just started looking into the Zobaline. Are there any other B supplements that people use that might be cheaper? How do you tell the difference between being weak from lost muscle mass vs neuropathy? I know for sure she has lost muscle in her hind legs/hips because I can feel the difference. Can I do anything to help her increase muscle again?

I had read that about the stridor in acro cats but as you noted she isn't on a high dose insulin so I kinda ruled that out. I didn't know that they could still have acro with lower doses. You mentioned your kitty has stridor too, if its not from acro do you know what else can cause it? I'm just so worried she's in pain when she breathes like that or that she isn't getting enough oxygen.

I have lab results posted under my SS link. Labs were done in both March and Aug of this year. Per those labs both vets claimed that her thyroid is fine. The first vet (March lab results) said she had CKD but the second vet (Aug lab results) said her kidneys were still fine and just looked like those of an older cat. Interestingly and still to my confusion, in March her glucose was normal and they said she did not have diabetes however she had the exact same symptoms of lethargy/weakness, polydipsia/polyurea, and noisy breathing, scooting, bloating as the reasons we brought her into the vet in March as when we brought her in in Aug and got the diabetes diagnosis. Basically in March they said she had CKD so we switched to low phos, moderate protein wet food. Her symptoms did not improve but were getting worse so we took her to a different vet in Aug that said kidneys were ok but that she has diabetes. The fact that symptoms were the same to prompt both visits but the diagnoses were totally different still bewilders me.

 

I should have added... My Willow (17 yrs old, weighs barely 7 lbs) has breathing issues. There is sometimes a subtle sound associated with her breathing, and she can at times sound very congested. She occasionally has what seem like coughing fits. There's a few different things going on with her. For one, she has always had issues with allergies. She gets 1/2 of a 10mg Zyrtec every day to help with that (as a bonus, it seems to increase her appetite). A specialist listened to her breathing and said the sound is on the exhale and is most likely related to something in the nasal airway... maybe some little growths. Without doing an endoscopy test, they could not be sure. I opted not to do that for now. I always have to balance risk vs reward when it comes to putting her through things. A chest x-ray was done, and it turns out that she has asthma. Those fits were really asthma attacks. (If you Google 'cat having asthma attack' you will probably find videos so you can get an idea what this looks/sounds like.) I have major air purification going on in my house to reduce allergens. Besides the Zyrtec, I also give her Canna-Pet . It is supposed to help with a lot of things, some of them being allergies, joints, inflammation. She was on Cerenia once because she was taking antibiotics that make her have nausea. I realized that during that week she had no asthma attacks at all. After she was off of it for a few days, they started back. I tried the Cerenia again, and they went away again. Cerenia is for nausea but it makes her asthma attacks virtually non-existent. So, she gets a very small dose of it (4mg) every other day.

Since you mentioned breathing issues, I just thought I would share all of that in case any part of it can help.

 

Thank you, I will look into the supplements/medicines that you mentioned as well as review some videos. I do think sometimes she is coughing. It sounds almost like she's trying to cough up a hair ball but nothing comes up.

 

Sounds like a possible asthma attack to me.

 

Kinda what I'm thinking.

Do you know of treatments for feline asthma that doesn't include steroids or something that would exacerbate her diabetes?

 

Check this out:

 

Looking at Butterscotch's spreadsheet, she's starting to spend lots of time, stably, in blues (at least during the day; really need to get a few nighttime tests to see what she's doing then!). But it's only been like that a few days-- still very early in the game. If she stays there (or blues+greens), without a lot of fluctuating back up to pink and down again, for a few more weeks and is still lethargic, then I might start getting concerned. If she's spending most of her time in normal numbers, even if she currently isn't used to that, it shouldn't take months for her to re-acclimate.

@FurBabiesMama gave you a much more thorough answer than I could. I really don't know what causes Amber's stridor, I've always assumed there was an environmental allergy of some kind contributing to it, though. She gets better for months at a time, then it comes back. I also have air purifiers set up everywhere to try to help her out, and they do seem to decrease her difficulties, but I haven't explored any other treatments (the vet has never seemed concerned when I've brought it up). She has never exhibited any breathing problems that sound like asthma, but it definitely sounds terrible when she's in one of her stridor periods-- as you say, like she can't get enough oxygen .

 

It's VERY important - probably the most important thing - to keep the air as clean as possible. In addition to having an Aprilaire filter system for my central air, I have several Alen air purifiers throughout the house. I have a wood-burning fireplace but never use it. Nobody here smokes. There are no air fresheners used... plug ins, oils, etc. I am hyper aware of everything we use or bring into the house. I mean everything....lotions, cleaners... don't want to track in grass/pollen. (The air is so nice, clean and crisp at home that I notice a difference when I go anywhere else. I have become a clean air freak!)

That video I provided a link to above talks about that and diet (low carb helps with this too!) as well as other things that can help.

 

Thank you both for all the info! Lots to look into. Definitely going to look into some supplements and improving our air quality.

Thoughts regarding just B12 vs a B complex?

Anyone have any thoughts on the bloating or twitching?

 

There is not enough B12 in a B complex. You want B12 for neuropathy. It should be methylcobalamin, preferably with folic acid.. This is why Zobaline is such a popular choice. https://www.amazon.com/ZobalineTM-Diabetic-Cats-60-tabs/dp/B008G3LI2M

By the way, something I did not mention before is litter. It helped a lot when I changed from a clay litter to Okocat natural wood clumping litter.