Help! Lack of energy in new sugarcat

Hi! I'm Holly and my sugarcat is Delilah, she's 11 and is a feral American shorthair I adopted at 8 weeks along with her littermate Sampson. She wasn't having any symptoms except for back leg weakness. Her bathroom, eating and drinking habits remained the same. 6 months prior I had changed them both to a high quality weight control diet of dry food and they split a can of friskies seafood pate at dinner. Sampson has only lost 1.5 lbs (22 lbs start) and Delilah lost 7.5 lbs (20 lbs start now 12.5). She was diagnosed on 12/5/17 and I started her on the Friskies only twice a day and she began 1U of Lantus twice a day 12/14/17. Before starting lantus she was very energetic, playful, and affectionate. She followed me everywhere constantly begging for attention likeherbrother. After the second day of injections she became lethargic anduninterested in toys or following me. She was still affectionate andeating well. Bathroom habits remained the same. I was concerned so I took her BG after her pm injection.
BG 15 min post injection (1U) 278
+1 BG 238
+3 BG 175
+6 BG 190
AMPS 247
Gave 1U 15 mins later after eating 1/2 food
+2 BG 192
I called the vet and she was pleased with how well Dee responded to lantus but concerned with how fast she dropped (initial BG at diagnosis was 593 12/5) and concerned about the lack of energy. She had me skip the PM dose and test the BG this am (12/17/17) if below 200 I was to skip the AM dose. She was 197 this AM so I skipped the dose and fed her. She's still lacking energy and over the last 3 days her poop has become very loose and smelly. I'm just concerned because she's not nearhypoglycemia levels but she's not acting like herself either. All her other labs and urinalysis came back normal except her BG levels. Her heart and lungs are healthy and her gums/teeth are in great shape. Anyonehad experience with this or advice? I included a pic of Delilah. Youcantell she doesn't feel well though

 

Any time someone describes their cat as lethargic, I strongly encourage them to go to the pharmacy and pick up Ketostix. One thing that will make a cat de-energized is the presence of ketones. You will need to stalk your cat to the litter box since the way you measure is to pass the paper end of the strip through the cat's urine (or get urine in a spoon, ladle, etc.) and follow the instructions on the box. Alternatively, if money is no object, your vet or the emergency vet can run a blood ketone test. Typically, blood tests (i.e., the big panels that the vet does in the office or sends out) don't include ketone measurements -- although electrolyte levels would be off if your cat was experiencing diabetic ketoacidosis (DKA) which is when it's a legitimate emergency.

A couple of suggestions...

Test before your given an injection and before you feed your cat. If you test after you shoot, you have no idea whether Delilah's numbers are too low for you to safely give an injection. If she eats before you test, the numbers may be influenced by the food. Lantus takes about 2 hours to begin working so you don't have to worry about food being onboard before you shoot. If your vet told you to feed before you shoot and test, your vet is more familiar with other types of insulin than Lantus.

Once a cat's blood glucose (BG) numbers start to approach normal range, they are no longer hungry all the time. In a normal cat, insulin allows glucose to enter the cells. In diabetes, there isn't enough insulin to get glucose (the end result of food being metabolized) into the cells so your kitty is starving -- literally -- so the cat loses weight and is hungry all the time. As BG levels normalize, your cat eats more normally. If your cat was drinking (and urinating) more than normal, this will improve, as well.

There is a HUGE amount of information in the sticky notes at the top of the board. It's a great way for you to become familiar with Lantus and diabetes management. One thing I would suggest is setting up a spreadsheet to help you keep track of Delilah's progress and it will also allow us to offer you suggesting and help, as well. We are typically very numbers driving and it's very hard to offer any information without benefit of knowing what's going on with your cat's numbers. The instructions for setting up a spreadsheet (SS) are here. If you have trouble getting this set up, let us know. There are a couple of members who are pros at helping with getting a SS set up.

Please let us know if you have questions. The people here are very generous with their time and knowledge. Welcome to the group!

 

I agree about testing for ketones-- it's always a good idea to keep an eye on that with any diabetic cat, and lethargy is one of the warning signs. If Delilah is too skittish or bashful to let you put a spoon under her butt, another option is to put some plastic wrap in the litter box where she likes to pee-- you just need a few drops to do the test.

Another possibility based on the one external sign (loose smelly poops) is pancreatitis. Does she seem like she might be in any pain (the usual way to tell is sitting in a "meatloaf" position)? HERE is some information on pancreatitis. If you have to take Delilah to the vet, ask them to test for it, either with the SNAP fPL (yes/no answer) or the SPEC fPL (takes longer, but gives an indication of severity as well as yes/no).

I think it's also formally possible that the Lantus just doesn't "agree with" her, but I can't remember hearing of that kind of reaction to this insulin (that shouldn't be taken to mean it doesn't happen, it's more a reflection of the state of my memory than anything else).

I hope she's feeling better soon, it's so hard to see them feeling yucky.

 

Thanks for the response! She's only been getting insulin 3 days so far. The vet did ketones tues before I started the injections thurs morning and they were fine. Just showed glucose in the urine. The vet is concerned because she dropped from 593 to 247 after only one day of insulin (1U twice a day) I gave her the regular dose the second morning but that night she was acting lethargic.. she had eaten and received the insulin only 15 mins prior to taking a BG. I took it multiple times and it never dropped below 170. The 3rd morning I tested before food or insulin and she was 247. So I fed her and gave 1U. I talked to the vet that afternoon and she had me skip the evening dose and checked her this morning before food and injection. She was 197 so she was only fed. Feeding time is the only time she really perks up. I had to come into work but I tested her before leaving and in 4.5 hrs her BG only read as 217. I'll test her again tonight before feeding but the vet wanted me to wait on the night doses so unless she is near 300 I'm to skip tonight's dose and check again in the morning.

 

That's actually a good response even though the numbers are high.

 

Those were her numbers after only 3 1U injections. This morning she was 24 hrs post injection at 197 so no insulin this AM.

 

How is she feeling today? Maybe grab another BG reading or two if you can today. That 197 24hrs post-injection has me wondering. How was she diagnosed? If she didn't have any of the usual signs (eating/drinking/peeing a lot), did you bring her in to the vet for something else? If she was diagnosed only on the basis of a glucose reading at the vet, it might have been artificially inflated by stress.

 

Ah... actually I just went back and re-read your earlier posts and see that her BG was in the 400-500 range. Vet stress may have influenced those numbers, but I'm not sure a non-sugarcat could get up that high on stress alone, so it does seem that Delilah is diabetic. But it's really good that she's been in the 100's-200's in the past couple days! Removing the remaining dry food has probably helped that.

 

This morning she was still lacking energy but she was responding more when I called her name. And she was being a little more vocal but still not acting right. Normally she's climbing on me for attention in the morning and when my alarm goes off she beats me to the bathroom to get ready. Then she follows me all over the house meowing for attention. At least today she's sitting normal to eat instead of laying down to eat. The vet ran full blood labs on her and they did a fresh urinalysis tues before starting the insulin on thurs to confirm the diagnosis. Everything was within range except glucose in both tests. I brought her into the vet because for about a week she wasn't jumping like usual and when she would walk on the laminate floors it was like her legs were sliding which wasn't normal for her. We've been in the house for 3 years now. So the vet is fairly confident that we caught the diabetes really early because there weren't any other signs or symptoms. BG this AM was 197 so no insulin and I tested it 4.5 hours later it was 216. I'm going to test it again around 6 pm tonight which would have been her PM time and see. I'll also check tomorrow morning at 6 am to see if she needs the injection then. I'm hoping that switching her to the Purina DM and friskies pate (that she was eating as a treat) is enough to bring her down and not need the insulin since she's started with a low dose of 1U twice a day and now possibly down to 1U once a day after only 3 days on lantus.

 

It'd be great if she were a diet-controlled diabetic, that's for sure! But in the meantime, her behavior is concerning. Definitely get a ketone test in asap, especially since you have skipped a couple shots. The "recipe" for ketones is: not enough insulin + not enough food + some kind of infection/inflammation.

If you do reduce the dose, it's better to shoot a smaller dose twice a day than the 1U once a day. We usually change doses by 0.25U at a time-- there are two procedures (Tight Regulation and Start Low, Go Slow) we follow on this board, described in the yellow stickies at the top of the page. But again, I'm mostly concerned about the lethargic behavior right now.

 

She should be getting enough food. She ate 1.5 cans of purina DM this morning between 6 am and 10:30 am. My vet is concerned about her lethargy too considering she didn't have any ketones in her urine 2 days before beginning insulin. Her brother is going for blood work tues since they are littermates but he's not showing any signs at all or weakness so it's more just precautionary. He also hasn't had the same weight loss. I'm taking Dee with us for the vet to check out as well though. But I will try to test her urine for ketones tonight.

 

Sounds like neuropathy setting in. Get her on a b12 methylcobalamin supplement to slow it down and reverse it. Many here use zobaline found on amazon.

 

I had the same thought as Janet. The difficulty walking may be diabetic neuropathy which can be painful. As numbers improve and if you give a methyl-B12 supplement, it will help correct the problem.

 

While I have the same concern about ketones, there's something else to consider.

When we first start insulin treatment, we're forcing their blood glucose into numbers their body isn't used to anymore. That's enough to make some cats act like they don't feel very well because they feel "different"

Think of it like how you feel if you're used to a lot of caffeine and you all the sudden stop drinking coffee.....you feel pretty bad for awhile until your body adjusts

 

Very true... and she started at nearly 600 so she's dropped over half just in 5 doses (2.5 days). She also has had very loose stools so I'm sure she has an upset tummy as well. Getting fortiflora from my vet tomorrow as none of the pet stores had any in stock this weekend her poor hiney looks so raw right now. I've been having to bath her or use wipes to get everything off. I think I'll have the groomer shave her hind end which I've had to do before when she had loose stools as she has very fluffy "pants". I'm sure that's not comfortable either. She is moving around more tonight though and meowing to be pet so that's good too!