Extreme hunger/vocalizing

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penni

penni

Member Since 2017
Hi all. Just joined and posted my intro last night (http://www.felinediabetes.com/FDMB/threads/my-senior-cat-gets-a-new-diagnosis.188502/). I have a lot to read obviously, but one question I was hoping to get feedback on earlier (though not an emergency at all) is just that my cat Akila has become SO desperate (and loud!) for food in the last few days, and I wonder if/how it's related.

She's always been...food-motivated. A great eater and always hungry. I'm so lucky she's a reliable eater - never had a problem getting her to take handfuls of pills and compounded liquids and anything else, especially if a treat follows. She's never been patient about her meals and as she's gotten older (she'll be 15 soon), she also seems to have expanded lung capacity to back up her complaints! This is especially hard at 5 or 6am for her humans.

Anyway, we had a rocky start to her diagnosis and insulin, as I mentioned on the other thread, so even a month in, there's nothing like any regularity to her dosage yet and I know I'm just at the beginning of figuring all this out.

BUT! With BG levels in the high 100s to low 200s, shouldn't she be feeling more satisfied and not literally *starving* like she was a couple months ago with BG levels in the high 300s? She's also drinking a lot more water this week, than she was in the first few weeks of her diabetes diagnosis/treatment. I just really thought with these lower BG levels she'd be less starving and thirsty? Am I just being impatient? What might I expect in this regard?

P.S. She eats Primal Raw Turkey - I'm currently giving her 2 bricks/2x per day, which is also a lot more food than she was getting pre-diagnosis (2 bricks per day, plus a few tablespoons of Acana kibble, which I have now cut out of her diet)
 
Is she keeping her weight on, or has she lost some weight? If so, what percentage loss.

Once you regulate a cat (80-130 during nadir) then their big hunger issues should dissipate. With Leo, he is hungry all the time. So some cats do stay hungry. I think some extra weight on a diabetic cat is good to get them thru the lean times.

Lots of drinking is typically a sign of unregulated diabetes. You said in the intro thread that:
- 180BG at 4 hour mark

We look for lower numbers at the 6 hour mark. And some cats do a nadir at 7 or 8 hours. Lantus is a good insulin for cats. But your cat may not be getting enough. The only way to determine this is through daily testing, including the nadirs at 6 hours.
 
JeffJ said:
Is she keeping her weight on, or has she lost some weight? If so, what percentage loss.
Click to expand...

Yes, she lost a decent amount of weight in the last 6 months. She'd always been chubby and vets always encouraged me not to treat food as a type of love to give her, especially with her heart condition. So actually and ironically, I think I thought I was finally being successful in bringing her weight down a bit, having lowered her Acana kibble from about 2 tablespoons to 1 teaspoon per meal. In retrospect, losing that much weight over a few tablespoons a day may have been unrealistic - and it was really the nascent diabetes. Her loss % might have been like 18% :eek:

JeffJ said:
Once you regulate a cat (80-130 during nadir) then their big hunger issues should dissipate. With Leo, he is hungry all the time. So some cats do stay hungry. I think some extra weight on a diabetic cat is good to get them thru the lean times.

Lots of drinking is typically a sign of unregulated diabetes. You said in the intro thread that:
- 180BG at 4 hour mark

We look for lower numbers at the 6 hour mark. And some cats do a nadir at 7 or 8 hours. Lantus is a good insulin for cats. But your cat may not be getting enough. The only way to determine this is through daily testing, including the nadirs at 6 hours.
Click to expand...

Yeah, I've added more food recently because now I want to get her weight back up, and hoping the insulin will keep up with it. Thanks for the feedback about nadirs and relative numbers. My first full 12-hour curve will be tomorrow, so I should get a better starting picture then. I've actually been filling the needle to the generous side of 1/2 unit already which with such small amounts, is practically a full unit already. So I'm probably giving more than 1.5 units total per day, and maybe will just make the jump to a full unit twice a day, depending on what her curve looks like tomorrow.

Probably something I need to read more about, but if I bump her up to 1 unit 2x per day, I should probably stay at that for a while and not bump her up a few days later if it's still not getting low enough, right? Is there an approx amount of time you stay at a certain dosage, at the beginning, even if you know you'll probably have to bump it up a little further? Just to give body time to adjust and react?
 
Hi Penni,

Suggestion: get some urinalysis test strips and check whether she's still excreting glucose in her urine; fairly likely if she's still exhibiting symptoms of polydipsia (excessive thirst). If glucose is present in the urine it will give you additional diagnostic information as to whether or not Akila is still spending part of the day over the renal threshold (BG high enough to require excretion in the urine). If that's the case then she may still be spending a significant of the day poorly regulated and therefore unable to to properly utilise the nutrients in her food, hence the polyphagia (excessive hunger).

For general information, polyphagia can be a symptom of other health problems, as can polydipsia/polyuria. Has your vet done a full blood work-up, including tests for kidney/thyroid/pancreas function?

Here's a helpful article on potential causes of polyphagia in cats:

Increased appetite in cats - causes, symptoms and treatment


Mogs
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Our Callie has always acted as if she was starving. Our granddaughter was always giving her snacks and treats. Now she runs at the sound of food, but she does slow down some near the end. For her, food equals love.
 
Our general guidelines is to limit dosage increases to every 6th cycle. So 3 days on one dose. But we also rely on BG test history, and there is not much I have seen from your kitteh. So I can't accurately tell you to increase or decrease the dose.

If you aren't testing at home, I recommend it. And it is helpful to us on FDMB to see the BG history. If possible could you start a spreadsheet?
https://www.google.com/url?q=http:/...942000&usg=AFQjCNEH66RqLY5FMfiH4JZdgWBsP5xtwA
 
Thanks for the info about dosage increase guidelines, that's helpful. And yes, I'll get a spreadsheet started soon!

I'm counseling myself to be as patient as possible. Her pemphigus flared up really badly when we cut back on her steroids as a result of the diagnosis, so we are back on a temporary high dose of steroids and getting started on some more drastic measures to hopefully eliminate the steroids eventually. But, I think that may be optimistic and we may always be battling between treating her paw (which, if you ask her, is probably a very high priority given that she can't put weight on it at all and has been basically a tripod for 6 months or more) and treating everything else. Her diabetes vet says he'd basically like to see us keep her in the 200s and low 300s while we focus on the paw aggressively. But, to the extent I can multi-task, I'm happy to do so! One of my more medium-term worries is that all the work I do to pinpoint her dosage right now won't be very useful when I step down the steroids in a couple weeks, but I'm not sure how strong the relationship is between daily doses of steroids and insulin, vs. long-term effects of steroids on diabetes. It's *complicated*!
 
No problem. Glad I can help. The spreadsheet will help both you and forum people - track progress, and trends over time.

The paw is a priority after all that time. High blood sugar can cause lots of issues. I don't know if it affects healing. The time you spend with diabetes education and dosing is good. Diabetes knowledge can help you make adjustments now and in the future.

Leo is on prednisolone. The daily effects are increased blood sugar during the mid day. Pred is a glucocorticoid - so it contains sugar as a component. (https://en.wikipedia.org/wiki/Prednisolone).

The effects of missing a dose is potential hypo.

The prednisolone (pred) affects some cats differently. In Leo the persistent effects are:
- increase in BG (blood glucose), requiring a little more insulin
- increase in appetite
...and it is supposed to reduce internal swelling, but I can't see inside Leo!

There are pred side effects for some cats. To my knowledge Leo has not had any.

--> Missed Pred Dose <<-- this thread shows the effects of a missed dose.
On Aug 11, 2017 Theresa forgot his pred pill. The impact was lowered BG the next day, and almost a hypo.

Overall, I have found the prednisolone to be very effective for Leo. He had reduced appetite, but the pred helped with that. The compensation for elevated BG is easy to deal with. Lemme know if you have more questions.
 
When you get your spreadsheet and regular testing routine going it will help you enormously with managing changing insulin needs. :)


Mogs
.
 
Jones is on pred and I have been up and down the dosage scale of that. Jones gets a mid cycle bump from the pred, but we have learned to work around that. In the end I made up my mine if the pred is what he needed and the dosage works - I will dose the insulin around that.

And I can confirm the missed pred dose. I went to the ER and had a back up do the dose but DS forgot the pred. I did not get home to very late at night and didn't test. I should of. He was low the next morning - really low. He was cold and lethargic. I ended up skipping his insulin, giving the pred and testing very closely until I was due to go back to the hospital for further testing. DH kept testing him until he was up to 54 which took almost half that cycle.

So when you decide to drop the dose...watch carefully!
 
Oy, Akila is on Medrol (methylprednisolone, a corticosteroid) and it can cause hyperglycemia, so it sounds like it will have some of the same challenges. We are on a very high dose right now for about another week, then will scale back to a standard dose while we start her on an aggressive immuno-suppressant therapy and see if that does anything for the pemphigus that could get her off (or scaled back) on the medrol. So another reason perhaps to just keep her insulin pretty moderate and just keep her BG from spiking really high while all these changes with the medrol are going to be going on.

When I was last speaking to her dermatologist, I was asking her about the wound healing - not that it could be worse than it has been the last 3 years, but now she's diabetic and my own father had to have part of his toe amputated from taking poor care of his feet, so I was picturing Akila having her toes amputated too! The derm said she didn't expect that, esp. given the constant care we are taking with the paw. But you know, it's not like it's helpful to have that added complication!

Speaking of, do any of you with cats with multiple issues see an internist? The derm was suggesting this might be a next step for us - to seem someone who has experience coordinating care for multiple issues across specialties. Honestly, the number of appointments and costs are starting to overwhelm me a tiny bit, so I was reluctant, but if anyone still reading this has done so (or considered it), I'd be interested to learn about your experience.

Thanks, all!
 
Jones has his own IM Vet. He is the one dealing with the IBD/pancreatitis . He is aware of the FD...but leaves that to me mostly. I highly recommend it if you can do it.
 
just a thought on the food/weight loss part..
4 bricks sounds like and actually looks like a lot/enough food but, one thing i ended up learning when my kittens weren't gaining weight was that the weight of raw and freeze-dried nuggets/patties often weight way less than an ounce so the recommended feeding guide amount is often way off and we end up under feeding our babies..
in your case 4 bricks IF they weight 1 ounce each (i don't recall them being so) is only like 180 calories (45 calories per ounce), not enough calories for most cats. Highly recommend you weight your girl's food instead of basing her meals by nuggets/patties. once i started doing that, my kittens weight shot up.
 
We had an internist for the Acromegaly. I knew almost as much as she knew about it, because it is not a frequently treated condition.

We have a "second-hand" internist for Leo's lymphoma. My vet consults with an internist on dosing and frequency on our behalf. I like this arrangement because it keeps our vet in the direct loop.
 
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