Diabetic cat always hungry. Vomits on empty stomach

Hello FDMB, I am a new member to the forum but I have been visiting the site from time to time since my cat was diagnosed with diabetes.

Percy is a senior cat (13 years) and was diagnosed almost two years ago. After his initial diagnosis he went into remission for a few months after switching him to fancy feast pate. Ever since his diagnosis, he is constantly wanting to eat. I honestly don't know at what point he would stop eating. As a result, he has actually gained almost two pounds. He soon developed another problem where he would vomit on an empty stomach (only bile). So I broke his feeding times up into more frequent, smaller portions throughout the day. I had to buy those automatic feeders to make this possible. Feeding times and portions have evolved as I tried to find a good balance between total amount and enough feedings to keep him from vomiting.

Currently, he is eating 4 cans of Fancy Feast pate per day. This is broken up over nine separate feedings per day. And in reality, he actually eats more than this because after inhaling his food, he finishes what the other cat left. Despite this, he still vomits at least once a week. I can tell that his throat is irritated due to the way his purring sounds. Also, occasionally there is a very small amount of blood in the bile that he vomits.

Remission didn't last long and he had to go back on insulin about two months later. After going back on insulin, his sugar levels remained high 200s/low 300s for an extended amount of time and I slowly increased his dosage at my vets direction. Increased doses did not seem to help so he was switched to lantus. Initially, after switching to lantus, his sugar remained high for a few weeks, but began to come down again and reached normal levels of low 100s at a dosage of 4 units. This lasted for 6-7 months up until around Christmas time last year.

During the holidays, I had to board him at the vet for the Thanksgiving weekend and he was so stressed while there he basically stopped eating. After he returned home he didn't eat at all for a few days, but eventually his ridiculous appetite returned. However, his blood sugar again rose to mid 300s and has stayed at those levels for the last 5+ months. Gradually increasing the dose of lantus didn't help. He is currently at 6.5 units.

My vet is not too concerned about the sugar levels because he wasn't losing weight and she said she doesn't worry about diabetic cats that aren't losing weight. She said the vomiting problem is likely because of his pancreas and she gave me some medication for nausea and told me to give him a small dose of acid reducer (tried both omeprazole and Pepcid AC). Nothing seemed to help his vomiting problems and both acid reducers gave him diarrhea.

I suspect that his sugar is higher has a lot to do with how much and how often he is eating. Basically, trying to balance his feeding amount/frequency with his blood sugar levels has been a nightmare. I haven't been able to find a balance and I am stuck because if I feed him less, I know he'll vomit much more frequently which will lead to the throat irritation becoming far worse.

Any insight/advice would be appreciated.

 

Good morning and welcome to FDMB. I know more experienced members will chime in to begin to address the vomiting issue, as this is concerning for you.
What I suggest, so that these members can see Percy's information and testing/insulin data is for you to create a signature and a spreadsheet. The more information provided,f the better they can advise.
1. Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished.
2.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

Knowing the blood sugar levels is important, in my opinion. If the BG is remaining high, that might account for the voracious appetite and vomiting. We have some very experienced and knowledgeable Lantus users here, but they will want the testing history to base advice on.
Very best wishes on helping Percy to feeling much better and making your life easier.

 

Thanks for the input. Signature and spreadsheet has been created.

 

I took a look at the spreadsheet and am a little confused. First, would you tell me where you are so I can get an idea of what time zone you are in. You can put your state in the profile information or in the signature so people know.
What time do you give Percy his insulin? The AMPS cell in the spreadsheet is for the test you get before the morning insulin dose, then the subsequent cells are the hours after that morning or AM dose.
The PMPS cell is the test you get before the evening insulin dose and I am not seeing that you are testing at either time. I do see testing data in the evening/nighttime +5 hour cell but not any insulin dose data beyond a 6 unit dose on 5/15.
Are you injecting Lantus insulin 2 times a day at 12 hour intervals?

 

Sorry, I missed the separate dosage column for the evening. I have only been testing him at night five hours after his evening dose. I can't test him during the day because I am at work. He gets his doses at 6:00 AM/6:00 PM and I test his sugar at 11:00 PM. I am in the central time zone.

 

My recommendation would be for you to visit the Lantus forum here:
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
Read the yellow tagged stickies at the top of the forum so you can learn about how Lantus works, and the protocols we use here with Lantus.
If Percy gets his dose at 6 AM, can you test before injection? and again before that 6 PM injection? It's important that you know what the BG is before you give insulin to prevent a hypoglycemic event. That information is invaluable.
I also suggest you copy your post here, and include the URL for this thread:
http://www.felinediabetes.com/FDMB/...-vomits-on-empty-stomach.215422/#post-2387095
and create a new thread in the Lantus forum. There are very knowledgeable and experienced members that can and will advise you better than I can.
The important thing is to get Percy balanced and keeping his food down.

 

Once a cat reaches six units, we recommend getting them tested for acromegaly. It is a condition caused by a benign pituitary tumour that causes excess growth hormone to be produced. In turn it causes diabetes, and can cause growth in soft tissue, bones, and organs. Excess hunger is often a sign. One in four diabetic cats has acromegaly.

 

Have you tried adding water to the food to make your kitty feel fuller?
Also have you tried slippery elm bark powder to ease the vomiting? I used to make it up into a slurry and give it to Sheba twice a day and it reduced the vomiting of clear fluid down to almost nil.
When does your kitty vomit? Is it early in the morning? I used an auto feeder overnight for Sheba and gave her some chicken stock each hour and then put the slippery elm bark slurry into one of the slots. This kept her tummy from getting empty and didn’t contribute to weight gain.

 

Hi Percy and his dad!
Do you have long work shifts? (i.e., more than 8-9hrs) Did you have any lab work done on Percy? We have someone who can look them over here too. I agree with Wendy, that you may want to get the acromegaly test done since he's over 6 units twice a day. It's becoming more frequent in kitties than it used to so some Vets aren't as likely to brush it off like before. Good news is even if he tests positive, you'll know and then we can help give suggestions for your treatment plan .

 

Thanks for the suggestions. I went ahead and copied my post to the Lantus forum. Here's the link in case anybody wants to follow along:

http://www.felinediabetes.com/FDMB/...nd-vomits-frequently-on-empty-stomach.215458/

I have not tried slippery elm. Is there a particular brand you recommend or does it not matter?

I am at work from roughly 6:30 AM to 4:00 PM. I'll see about getting him to see a vet next Saturday to see if they will test him for acromegaly. Percy's last full lab was done in Feb 2018. His previous numbers from August 2017 are alongside those numbers in the images below. Labs are below. I did have the vet test for hyperthyroidism a few months back as she said his thyroid was enlarged after examination. That test came back normal.

 

Hi Percy's dad! Sorry for the delay in getting back . Interesting that he was diagnosed in Aug 2017 but his BG at the visit for Feb 2018 was 206mg/dL . Apologizing again because I don't seem to have any useful information for this post, just an observation response . Did you find anything out at the Vet visit?

 

Thanks for checking. There is more discussion in the thread I posted in the Lantus forum if you want to take a look at that. I had a phone conversation with the vet and discussed the possibility of testing for those insulin resistant disorders, but the treatment won't change even if he is diagnosed with either. So I decided to spare him the vet visit. The test results I posted were a follow up in Feb 2018. If you look at the column on the right, You'll see his test numbers from his initial diagnosis in August 2017. For now, I'm just slowly increasing his insulin dose to hopefully reach a point where his BG starts returning to normal levels. Here's the link to the Lantus forum thread again if you're interested.

http://www.felinediabetes.com/FDMB/...nd-vomits-frequently-on-empty-stomach.215458/