Cat losing appetite after starting insulin?

Hi, I'm new here, so my apologies for the long backstory. I have a 15 year old male cat who was diagnosed with diabetes in late October 2019 after having a DKA event. He spent three days/nights at his old vet's office and was put on Vetsulin (2 units every 12 hours) and wet food (Friskies Pate. He had been a dry food grazer his whole life up to that point). His recovery was quick, and things were going great for about a month, then he slowly started eating less and less of his wet food until he got to the point where he was eating so little that we shouldn't have given him a shot (even the lowered dose of 1 unit) and he had a hypo event where we ended up having to take him to a 24 hour animal hospital for observation.

They had us stop his insulin for a week, put him on whatever diet we could get him to eat, and schedule a visit with his vet. We started feeding him Hill's m/d dry food (one quarter cup twice per day), he ate well, but without his insulin he started showing clinical signs again (gradually drinking and peeing more each day). His old vet's office said it would be about a month before they could see him again, so we switched vets and got him in to a new one immediately.

The new vet put him on Glargine (2.5 units every 12 hours) and a new feeding regime: twice a day, he gets fed a quarter cup of Hill's m/d dry food and gets 30 minutes to eat as much of that as he can, he gets his shot, and then we have to pick up his food. He did fantastic on this new regimen for a few weeks, eating about 90% of his meals on average, and showing great clinical signs (and acting more playful and energetic than he has in years!).

Now all of a sudden he is eating less and less at meal time and therefore not getting his full dosage of Glargine. We have even had to skip two doses entirely this week because he only ate about a third of his dinner those two nights. His clinical signs are still fantastic, and he seems happy and healthy, but we're worried he's going to backslide if he's not eating enough to cover his shots (and after experiencing a hypo event before, we are apt to err towards lower or even no doses when he doesn't eat well).

He seems plenty hungry and even looks around the kitchen as if he's looking for something else to eat, but he just walks up to his food and takes two bites and walks away (and after a while just walks up to it and turns up his nose and walks away, looking at us like he'd like something else to eat). He seems to be following the same pattern as he did when we had him on the wet food: gradually deciding to eat less and less of it as the weeks go by.

Has anyone else experienced this? If so, what was the cause/solution? We want to avoid trying to entice him to eat more by doing things like sprinkling a little cheese on his food or anything like that because we went that route with his wet food and it seemed to backfire (he'd lick off the cheese, not eat any more food, and beg us for more cheese). Thank you for reading, and thanks in advance for your help.

 

Try give him some wet food again. Try Fancy Feast, they have such a wide selection and you find it on here on the Food Chart https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

He is 15, that is an considerable age. And if rotating his food is what it needs, then in my humble opinion, do that.

 

Thank you for the suggestion. He absolutely will not even go near wet food now though unfortunately. It's almost like he always hated it but suffered through it at first knowing he had to in order to get better but now that he feels well he's against the very concept of wet food as food.

I am, however, contemplating trying out a new dry food (something like Tiki Cat Born Carnivore) for him if his poor eating continues.

 

Do you think it’s possible he may be nauseous? Any lip licking or deep swallowing? He could just be being picky, but sometimes wanting to eat but walking away can be a sign of nausea.

My cat does not get any dry food but when she has pancreatitis and is nauseous, she will not eat wet food and I feed her the Tiki Cat born carnivore chicken and fish luau. She absolutely loves it, it smells just like smelly fish food It’s definitely not low carb, but I don’t think it’s the worst dry food, maybe somewhere around 13% carbs. Young Again and Dr. Elseys are the only two dry foods that are truly low carb and okay for diabetics

 

It's possible that he's nauseous, but he doesn't really seem like it (and acts like he wants to eat/begs for other food). He has however always seemed to have a little trouble with chewing the Hill's m/d with how tiny the pieces of kibble are, but like I said he used to eat on average about 90% of his meals.

The info I've found on the Tiki Cat Born Carnivore (chicken) says it's 10.8% carbs, which is actually less than the Hill's m/d despite it supposedly being specifically made for diabetic cats (15.1%). I WISH he would just eat low/no-carb wet food, but that seems to be off the table for him.

When he was first diagnosed, I never in a million years thought that giving him his shots would be a breeze (he actually seems excited for them each time!) and getting him to eat enough would be what causes us so much stress!

 

Most of the calculations will not be entirely accurate because they’re usually based off the guaranteed analysis, which is just minimum and maximum values, but they will give you a general idea. Yeah, hills is not great at all for diabetics, despite what they try to say!

If you think he may be nauseous, it might be worth talking to your vet about trying an anti nausea med to see if it helps. Cerenia is one option but is typically better for nausea with vomiting, and ondansetron is another option. You mention it seems like he has trouble chewing as well, does he have any problems with his teeth??

I’m not sure what kinds of wet foods you’ve tried but it might be worth continuing to try to find one he likes. There are all kinds of flavors and textures, which can make a difference for some cats. My cat will not eat anything shredded or chunky and only prefers pates, while other cats like some texture. However, I’m not sure if you’re home testing your kitty so do be aware that changing to a food thats lower carb than you’re currently feeding, wet or dry, has the potential to affect your cats blood sugar and how much insulin they need.

 

Agree with Sarah&Soph that it sounds like nausea or pancreatitis with the turning his nose up at food.

• You are describing classic symptoms of chronic pancreatitis. Turning his nose up at food, turning away from food, refusing to eat. Sounds like recurring bouts of pancreatitis to me. Would explain the multiple episodes of eating well and then gradual decline.
  
• Pancreatitis is common in cats with diabetes. Look at this document, A Primer On Pancreatitis for reference.
  
• Have you checked him for dehydration? Press finger on gum, should pink right back up if not dehydrated. If it takes a bit longer to pink back up, dehydration.
• You can do the skin tenting test also as a quick at home test for dehydration. Pinch a bit of skin in cat's shoulder, pull up gently, and it should snap back into place. If it stays up, severe hydration and cat needs fluids ASAP. Vet visit.
  
• Maybe a fPLI test for pancreatitis or a SNAP fPL in vet office.
• Pancreatitis is painful. He may need pain meds.
  
• With past DKA, you need to be doing daily ketone testing. Classic setup for DKA is not enough insulin + not enough food + infection or inflammation.
  
• Not eating can also lead to hepatic lipidosis.

Right now, the most important thing to do is get him eating. Anything. Don't care if it's low carb or not. Hand feed him if necessary. Assist feed if needed. Feeding tube inserted by vet. If nauseous, he may simply vomit the food back up. He needs anti-nausea meds like ondansetron.

Bottom line. Your cat is telling you he is sick. You need to see a vet to help your cat. The sooner the better. TODAY. Please don't wait.

 

Thank you for your concern and response. I am fairly certain though that it is not pancreatitis. He has been tested for it multiple times since his DKA (with great results) and is showing no symptoms other than a few poorly eaten meals (in fact, he is probably the furthest from lethargic that I have seen him in the 7 years I've know him). He has also consumed around 125-150 calories total even on his worst eating days. That's not to the level of what we want him eating, but I don't think he's in any danger of hepatic lipidosis. His doc thinks it's either (from most likely to least) behavioral, a dental issue, or a sign of partial remission.

 

I'm a newbie, so take what I say with a grain of salt. My Billy is headed for remission, and we absolutely had some days when he wasn't eating enough. Every cat is different, but what worked for us was warming his canned food slightly. Just to warm, not to hot. In our microwave, it was like 10 seconds. And keeping to low carb pates, but switching flavors often also helped keep him interested. I don't know if it will help your sweetie, but it's worth a try.

 

Hi SullivansDad,
You have been getting great help.
Would you consider setting up a spreadsheet so we can see your data on the BG numbers? I will put the link at the bottom in case you would like to. It would help a lot in helping you.

I think antinausea meds is worth a try. Cerenia or ondansetron. If he appears hungry but won’t eat, that is classic nausea sign.

I will also put a link to stimulating cats appetite below.

I would be very cautious about stopping insulin in a cat with a history of DKA before his is in remission. I would be testing the urine for ketones with Ketostix.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

 

Thanks everyone for your support! He ate like a champ tonight. I really don't think he was ever nauseous or lacking in appetite, he's just not always going to eat a full half day's worth of food in 30 minutes. That would be like me eating a whole large pizza in 30 minutes; yeah I could do it, but probably not every 12 hours (probably).

After speaking with his doc today about adjusting doses based on how much he eats in his 30 minute mealtimes (and taking all the great advice here into account), I feel like I have a pretty good handle on things now. Thanks again!

 

One thing I forgot to mention is there is absolutely no need for Sullivan to eat a full meal in 30 minutes and then nothing til the next shot. Now that he is on Glargine/Lantus he can have about 1/2 his mornings food Preshot, then divide the other half into two snacks and give it to him at say +2 and +4 or 5. Then do the same with the evening cycles. That is what most of us do here. I wouldn’t want to eat all my food at once either. That was the old way of doing things with older type insulins but with newer insulin it is better to feed smaller meals more often.

It would be good if you could set up a spreadsheet and your signature so that we can help you more. We look at both when helping you.
here is a link for new members which has the links needed.
please keep posting so we can help Sullivan.

how much does Sullivan weigh? 2.5 units is quite a large dose for a newly diagnosed cat. Are you home testing the blood glucose levels?

 

Link that Bron and Sheba meant to give you is this one I think
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