New diagnosis of DM for cat with chronic liver disease

Lovely Luna has been managing with a portosystemic liver shunt, cardiomyopathy and hypothyroidism for 9 years. If all that sounds like a lot, you'd be amazed to see what a wild, healthy, rambunctious girl she has been. She wasn't supposed to live past 6 as her maximum life span, so we know that every day has been a gift. She has been a real trooper getting four to five meds twice a day all her life ... she's had a feeding tube for Hepatic Lipidosis ... and she's had more pokes and prods in her dainty little body but has still maintained a great disposition.

So imagine our heartbreak today when, after a spell of not eating and lots of water consumption, she was (not surprisingly) diagnosed with diabetes. I'm very confident in our ability to manage her, as our lives for the last eight years have all been organized around her care. What I am worried about is how this all works with her liver disease. For example, she takes Lactulose twice a day -- and it is full of sugar!! How will that work? And her diet is very strict -- only Science Diet L/D because it manages her liver. Will she be able to continue eating that?

Any/all advice/support is welcome. We're prepared to go the long haul with her, but definitely need assistance managing this complicated little girl. She will get bloodwork back tomorrow, and then she'll go in for the first day of insulin and monitoring.

 

Hi

Welcome to the FDMB!
Your kitty's name caught my eye, I have a Luna too, but he is a boy

I have no experience with the health issues your Luna has, I would like to say thou - what an amazing mom you are to treat and care for her so well. She is a very lucky kitty.

I have a couple of questions,
How was the diabetes diagnosed? What test were done to indicate feline diabetes?
Has your vet mentioned what type of insulin you may be using?
Whichever insulin you go with, the board here has forums for all the insulins used for kitties.
Will you be home testing? Home testing is the best way to manage feline diabetes, you may be told by your vet to bring in Luna for regular "curves", but this can add up in $$ and the typical "vet stress" tends to raise BG levels for kitties.

I know there are quite a number of members here who are dealing with other health issues on top of feline diabetes, I am sure they will be along to offer support and suggestions.

In the meantime, there are so many links I'd add on here,
but I will do the main one to the FDMB HEALTH LINKS page
viewforum.php?f=14

Here you will find links about home testing, hypo and the ultimate hypo tool box list, diet and nutrition, Dr Lisa's Feline Nutrition website is very handy and informative., plus Janet & Binky's (GA) food charts that many members use to select appropriate foods.

Like I said, others will be along to give you more feedback, feline diabetes is treatable and very manageable.
Good luck to you at the vets tomorrow!

 

Hi, and welcome.

Just briefly I'll say to others reading this thread: this kitty needs a low-protein, high-carb food and needs lactulose and there is no way to decrease or alter either of these. They are vital for a kitty with a portosystemic shunt. (We are big on diet around here so I'm just mentioning this so well-intentioned folks have all the facts.)

As for you and Luna, you'll just manage the diabetes around the lactulose and the low-protein food--managing her liver disease takes priority. Hometesting the BG will help you immensely, and we're all here to support you as well. My late cat, as well as others around here, needed to be on prednisolone (which causes insulin resistance) and his diabetes was managed around this medication which was vital for him. It can be done If your kitty will permit it, appetite-wise, the first thing you can do is start feeding her and giving her meds at regular times (within 30-60min time frame) during the day.

Lactulose is supposed to be an indigestible sugar, IIRC, but I think some members here have noted some BG fluctuation with it anyway.

I'm curious to know if your kitty had shunt surgery? Any symptoms of encephalopathy? Lactulose enemas or by mouth only?

 

You will get a lot of advice, some of it in the form of canned posts from people who have not read the entire thread. Jess is a veteran vet tech at the emergency and specialty hospital I use, her advice is from both experience and expertise. Please ignore anything, however well meant, that contradicts her.

And on a lighter note, we're real good at cheering on a sugarmom (you have become one) dealing with a difficult situation. Come and rant, if you need to, or just share your stories.

Gia & Quirk (GA)

Guilt trips are a detour from life

 

Hi everyone. Thanks for all your posts. It's a great sense of community.

OK, let me start with what's been done so far. She was dx'd with a portosystemic shunt in 2002, and had hepatic lipidosis and a feeding tube. She did great with that and has been well managed and completely stable since then. Her shunt was never visualized on ultrasound, but the specialist said her liver values and encephalopathy all supported it. And frankly, on the meds, she has soared! Her daily regimen has been L/D food, and then lactulose, amoxycillin, lysine, synthroid (she's hypothyroid) and diltiazem (she's tachycardic). She also has some mild cardiomyopathy. If that all sounds like a lot, I have to reemphasize how healthy and sprite she's been for many years.

The past week she stopped eating and lost 1.5 pounds. She was drinking excessively and looking lethargic. They did a urine sample and found ketones, and they also did a blood draw. I just got off the phone with the vet who had the blood results, and now I am really concerned. Her blood glucose was 305, so they want her to start on insulin immediately (name of it starts with a "G"?). My better half has had experience with managing a diabetic cat, so we're confident about doing the home BG checks, and our vet is supportive of that.

Now, the really ugly news, is that her liver enzymes are elevated, AND her calcium level is 14.2. The vet isn't sure yet if this is suggestive of peroneoplastic syndrome, lymphosarcoma, or what. I have some vague recollection that in her past history, there was a question of hyperparathyroidism and hypercalcemia, so we're checking back with our previous vet. Fortunately, our previous vet (we moved 2 years ago) is a board certified internal medicine vet with a practice that specializes in cancer and other complicated cases. She has agreed to consult via fax with us today so we can come up with a plan.

Little Luna ... our special needs child!!! Thank you for all your input -- good wishes and prayers are welcomed, as along as all the advice you want to heap on!

 

Hi there and welcome!

Boy you guys have a lot going on!

I will try to address your latest post but only as a lay person so take it with a grain of salt please

1. ketones - what are they doing about them? They absolutely must be treated or this whole issue can spiral to a very serious condition called diabetic ketoacidosis

2. liver values - in a cat without all of the issues you are dealing with, it is normal to see elevated liver values when a cat is newly diagnosed. In your cat, I'm not certain if this applies at all but I wanted to mention it.

I really hope that your vet can help you get a handle on this as it sounds like you both have been doing so well!

Jen

 

sounds like Glargine also known as Lantus.
here is a link with the basics of handling and storage of Lantus

Proper Handling and Storage of Lantus(Glargine)
viewtopic.php?f=9&t=151

 

Hello!
I know this post is 5 years old, but my cat has many of the same diagnosis of Luna and was wondering how difficult it is to manage the diabetes with a liver shunt? Like Luna, we have been able to manage Puff's shunt with several meds twice daily for over 10 years now. The newly diagnosed diabetes has me a little stressed about changing our routine. I'm not sure if Luna's parents will see this, but it's worth a try and any advice in juggling it all would be greatly appreciated.