A little too runny on the other end...

Hi all,
Not the most pleasant of topics, so I apologize, but I've been pouring through the internet for a couple of hours now to try to figure out what to do and figured that in the end, this was probably the best place for me to ask!

Poor Neo seems to be suffering from near chronic diarrhea. It ranges from being really wet (and really noisy on the way out ) to semi-loose. Every once in a while it gets to what I would deem a "normal" consistency. I'm concerned that this is really bad for Neo since he has diabetes. I've complained to the vet and first time was told that the antibiotics he was on was probably causing it (okay, fair enough), but the problem is, it never seems to go away. They've prescribed Finidiar for him a couple of times now, but in my opinion it's not helping - or it only helps while he's actually taking it.

Do any of you have experience with this? I now have the impression that this isn't necessarily a side effect from diabetes, so I'm wondering if it's his diet. I can't get a hold of most of the generic American labels that I've seen mentioned, but there are a few Canadian brands that have recently popped up on a site that I usually buy food from. Has anyone heard of Acana or Orijen? Or could my wet food be the culprit? I really thought Applaws would be good because they say they're 100% organic, 75% pure meat and 100% gluten free. I asked my vet about the food and unfortunately all I got was "that should be fine." :-|

Any suggestions to help with this would be very much appreciated! Thanks so much!

P.S. I'm getting ready to go on an extended holiday/business trip for 2 months in 2 weeks so I also am worried about changing his food too much before I go. I feel guilty about leaving him behind :-| but I keep telling myself that it's my first holiday this year and I've found a really good place to put him up for the duration, with someone who has experience with diabetic cats. Expensive, but definitely (hopefully) worth it.

 

Saima used to have really soft stools on certain foods. I think maybe they were the foods that were higher in fat or "too rich"? (Blue Basics Turkey and Potato was one of them), though I'm not sure about that. We just kept switching foods (which was a real picnic due to her allergies) until things firmed up. In her case it usually seemed to be the dry food that was the issue. The more moisture she took in with her food, the better her stools seemed to look. I could be wrong about that, but that was always my impression.

The other thing that comes to mind is that I seem to remember Dr. Lisa's discussion on raw food mentioning that she had to add fiber (ah, here it is... scroll down to the section on "constipation": http://catinfo.org/?link=makingcatfood) to her cats' raw food because it actually made their stools a little too dry and crumbly. Maybe some form of raw would be something for you to consider if it has that side effect? Also, if it's antibiotics causing it, maybe you could try some Purina FortiFlora probiotic sprinkled on his food to try and get things back in balance?

I'm really sorry you and your kitty are going through this, though, and I have to admit that I am just taking wild guesses here. That sounds a lot worse than any diarrhea Saims ever had.

 

Hey, I know the feeling, about kittys having Diarrhea/runs etc... :sad: In our case my cat was eating hard food/wrong food. This was when we first realized he had diabetes. If he eats just his fancy feast chicken can food, he has the "RIGHT" kind of POO! But, if he slips up and gets into anything else, he will be back to the nasty, loud runny poop! YUCKY!

But, there can other reasons why your kitty has diarrhea, Someone here in this forum CAN HELP you! Maybe u could put a 911 icon with your post, And see if that helps.. I have a thread I posted when I first found out my cat had F.D... and those ANGELS, o helped me get myself together, and on the right track! And trust me, I needed it!

Find my thread, and look at the girls who responded.. Tell one of them your issue! But, Try to post again, with the 911. I wish I could help u more.. I hope you find help very soon! Hugs, Pam , Po-kitty and all of my other FUR-BABIES! cat_pet_icon

 

SEE! I new someone would HELP!! o

 

I've found that fortiflora (a probiotic) works quite well for temporary runny stool problems. However, it sounds to me like you may need to change the diet if this has been going on for a while, and you're sure it's not the antibiotic's fault, or a parasite. Many of the grain free higher end foods are very high in fat and this can cause chronic poo problems. I would try a food with a lower fat content, even if it has byproducts. Recently, Dr. Pierson amended her commercial cat food page to say this:

If that doesn't work, you might want to try a raw diet. Many cats with IBD or other gastrointestinal problems have their vomiting/poo issues clear up on a raw diet.

 

just had that problem recently...come to find out its the food being out and it being too warm outside...assuming food was getting bad since we are on the EVO ..started putting it in the fridge when i was home and all is solved.

 

Hi all,
Thanks so much for the replies! Neo is going in to the vet tomorrow so I've been gathering stool samples and I'm bringing them in with me. Sounds like food may indeed be the problem and thanks for the tip about the food being too warm! I will try moving it to a spare room that's always dark and see if storing it there helps. And thanks for the links too - I will have a read through and once I'm back from holiday see if I can slowly change his diet. I'm also planning on starting home monitoring once I'm back as I'm really concerned what will happen to his blood sugar if I take him off the Royal Canin Diabetes dry food.

Does anyone have any experience with Royal Canin Diabetes, by the way? I am really tempted to dump it because some of the other brands I've been looking at seem to be better qua ingredients. According to the label, it has:
Protein - 46% Fat - 12% Ash - 6.4% Fibre - 4.6% Essential fatty acids - 2.81% Starch: 17.4% Total sugars - 1.9%
Any opinions? I thought it must be good since my vet told me to use it, but if I'm paying 65EUR for a 3kg bag and it's not even very good, I'd really like to know. :?

Thanks again all - you guys are amazing! And sorry for the late reply - I forgot to tag to be notified so I was thinking no one had answered yet. Really appreciate all the support and advise!

 

I would get rid of the dry food completely. Dry food is too high in carbs for diabetic cats, even the prescription diets, and will cause setbacks in treatment of Neo's diabetes because it keeps his blood sugar at high levels.

I recall from a previous post that you're on 4u of Caninsulin? Have you looked into switching insulins? A slow acting insulin like Lantus or Levemir works very well in cats and has a very high remission rate when paired with a low-carb, canned diet. If your vet won't prescribe it for you, I would call around and see if you can find one experienced with feline diabetes who will.. Caninsulin just doesn't have a long enough duration of action to work well in cats.

Regardless of whether you make an insulin change or not, please make sure you lower your dose of insulin if you remove the dry food. Cat's blood sugar levels can drop 100-200 points over night with a diet change, and if you don't lower the dose it can cause a dangerous hypoglycemic incident.

 

You're absolutely correctly - we're on 4u on Caninsulin. I didn't even realize that I had other insulin options, but I will be sure to ask the vet tomorrow to see if we have any choices.

And thank you for the advice about the dry food! I may indeed give it up completely and see what happens. But only after I've done the home testing and feel confident that I can monitor his levels.

This may be a stupid question and something I shouldn't be worrying about, but - do I have to worry more about his teeth if I take him off dry food? I have a cat toothbrush and toothpaste, but have been hesitating to use them on Neo because I have no idea how that might affect his blood sugar.

 

I've attached an article to give to your vet in case they're hesitant to prescribe a different insulin--most vets are just a little behind in their reading and once they are presented with research that supports the prescription, they'll go head and write it. This article only came out a couple years ago and vets have a lot they have to keep current with.

You absolutely don't need to worry about his teeth any more than you already do. Dry food does not do anything to help cat's teeth--this is a myth. Think about a cat's dental health the same way you would yours--do you maintain your teeth by going to the dentist for periodic cleanings and brushing your teeth, or do you eat crunchy cookies all day long? It's the same thing with cats. The two huge factors that affect the health of your cat's teeth are genetics, and periodic cleanings. Both my cats ate dry diets for the majority of their lives, and their mouths turned out to be absolute garbage. Bandit is just genetically prone to tooth resorption, and Gabby should have had regular dentals, but I just didn't know because back then I believed Gabby's old vet in the 1990s when he told me the dry food helps teeth thing, too. My friend Victoria's cat has had a solely canned diet for most of her life, and she took her in for annual dentals, and at 16 years old she has all of her teeth in great condition and is a very healthy cat. It's not a stupid question though--some vets even still perpetuate this myth, even though there is no evidence to support it.

You definitely want to start home testing as soon as you are able! Dose adjustments via home testing, a low carb canned diet, and a slow acting insulin are the three key factors in getting your kitty's diabetes under control. We have tons of tips and tricks here to help you out! Also post back if you need help with canned food suggestions. Here's Janet and Binky's International food list: http://binkyspage.tripod.com/nonusfd.html. You want to look for something under 10% carbs, but preferably below 8%. If nothing on the list is available near you, you can also tell if a food is likely low carb by reading the ingredients on the can. You want to look for something that doesn't have any grain--no rice, soy, wheat, corn, and either no or very small amounts is vegetables.

 

Thank you so much! I'll print out the PDF, read it and take it in with me tomorrow to ask. My vet seemed really cranky at first, but warmed up when she seemed to realize that I was just going to bat for my cat and was doing whatever I thought it took to make them take me seriously. So fingers crossed that she won't be offended but will applaud the fact that I'm researching all this - with your help of course!

Duly noted on the food. I have indeed been told that dry food will help keep teeth clean. But darnit - did you have to take away my excuse for eating cookies all day long? :lol:

I have bought everything I need for home testing so I will definitely start as soon as I'm back from my holiday! I will just pray that Neo stays in good health until then. And thank you so much for the tip on what to look for in carbs. I have just found a fresh, frozen food that says it has 0% carbs in it, especially for diabetic cats, so maybe I should give that a try. I will just have to make room in the freezer - I still can't get over how little freezer space I have here compared to back in the US. >.< Do I need to worry about anything else in the ingredients? It's called Carnibest, and contains:
19% Protein, 12% Fat, 2% Ash, 1% Fibre, 66% fluids, .54% Calcium, .47% Phosphorus

Thank you again!

 

Ugh. I will have to read this more carefully later, but this caught my eye on the first page

If that's all they can use in Germany, it's probably the same here. But, I will ask anyway!

 

Hey, I'm not taking away your excuse to eat cookies--just that excuse! :lol:

I looked up the ingredients online for you: http://www.carnibest.nl/ That food looks great! Just make sure it says somewhere that it's a complete and balanced diet for cats. You want to make sure it's not just a supplemental food (for example, it must contain taurine to be balanced), but from what I saw it looks like it is.

They actually have a few other types that would be ok to feed as well! You can also feed the Eend-mix, and the Kalkoen-mix if you would like.

I think your best course of action would be to change the diet and the insulin together. That way you can start down at a lower, safer dose while you make the change. And of course, you'll want to be testing as well!

Who is going to be taking care of Neo while you're away? Do you have a sitter or will he be boarded? Will they be testing him while you're gone?

 

Here's another document for you to print for your vet: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

Lantus or Levemir are really the standard insulins now prescribed for cats. I would emphasize to your vet that worldwide experts in Feline Diabetes treatment recommend the insulin and protocol you're providing her because of the very high remission rate. Just because legislation has not caught up to the research is no reason to let cats suffer on insulins that are dangerous and unlikely to help them. The law does state that it be the first insulin used...it doesn't say it has to be the only insulin used! Perhaps just the fact that you're on it now is enough to satisfy the the law. The protocol for Lantus in cats was originally tested in the German Katzen forum, and there are many people there who use it, so there must be a way around it.

In the US, you can't even get this insulin anymore because there were major quality control issues: http://www.felinediabetes.com/FDMB/viewtopic.php?f=19&t=311.

 

Keep in mind that just becauses it's the only one approved for use, doesn't mean it's the only thing the vet can perscribe. I use to have pet rats, and there are only one or two antibiotics approved for use with them. However, it was perfectly legal for the vet to perscribe other medications once the approved medications no longer worked. I realise I live in the US, so it may be different, but I imagine it is a similiar situation regarding the insulin for you. Also, chances are at one point or another Lantus was tested on cats in a lab before it was approved for use in humans, so if your vet gives you trouble about trying the Lantus, try to find a lab study on Lantus and see what animals it was tested on. If cats were in the study, that may be enough to persuade your vet to try it.

 

Well I've done more poking around online - this time on a Dutch site - and it turns out some people are indeed using Lantus over here, so that's good news! I'm going to talk to my vet about switching over today.

But one huge worry for me - I will be more or less continually traveling for 2 months, starting in less than 2 weeks. If I don't change his diet and switch him over to Lantus, will there be any problems? I am leaving him with a cat sitter who has experience with diabetic cats, but I know I can't ask her to home monitor him and change around his diet. I'm worried that the change of environment will be enough stress for him as it is, but unfortunately I couldn't find anyone trustworthy enough to come over twice a day to take care of my cats while I am away.

What do you guys think? Go ahead and ask to switch or stick with Caninsulin and then switch and home test (and follow the protocol) once I'm back? :?

I feel really bad because the article says if the protocol is followed within 6mos of initial diagnosis the remission rate is 84%, and it drops significantly after that. But it's too late for me to change all of my plans now. I am getting back just under the 6mos period so I will have to jump straight back into everything as soon as I'm back!

 

Just got back from the vet. Neo's bloodsugar levels are actually higher than last time. And apparently he was pretty angry at the vets - there's a note in his "report" that he was getting angry and being pricked, poor little guy.

I had a pretty big discussion with the vet - she knows about Lantus and said they're only allowed to switch to it after following the protocol. She said that his curve is actually looking pretty good and recommended that we stick with Caninsulin for now. And she strongly urged me to start home testing, and was very pleased when I told her I'd already bought the stuff to do so. His dosage is upped to 5 IE now as he's still hovering close to 20 mmol/L. She also encouraged me to look for scientific literature showing studies of the effects of caninsulin. I have found only 1 so far, and it's 30 bucks for the paper. Does anyone know where I could get some for free? A search on Google didn't really help...

His test results (in mmol/L) were:
0815 - 18.2
0850 - 19.4
0915 - 20.2
0945 - 20.2
1030 - 16.8
1100 - 14.9
1200 - 20.0
1300 - 19.7

Since he's going into a pension, I'm just going to have to stick with what the vet says for now. The lady he'll be staying with has experience with diabetic cats and giving injections, but she's not going to do any home testing for me so I'm not comfortable taking the risk with changing his diet. At least I have just under 2 weeks to keep an eye on Neo with this new dosage to make sure he's gonna be ok. I guess that'll have to do until I'm back.

Oh - and thank you so much for taking the trouble to look up the makeup of Carnibest! I will just send them an email directly (after checking on their site) to make sure that it's a meal in and of itself rather than a supplement - thank you for the tip. I was indeed eyeballing the other mixes, but was a bit concerned that they had a higher fat percentage. Then again, seeing as how Neo's weight seems to remain in the 4.6 to 4.8kg range, I guess a little bit of ;-) extra fat won't really hurt him.

The good thing is that the vet told me that if I read the articles and was still convinced that Caninsulin wasn't working and Lantus was the way to go, then she would write in his records that Caninsulin doesn't work and prescribe me Lantus. So I am coming away feeling fairly happy. My vet seems well-informed about the options and also appreciates that I'm doing research myself and challenging things so I'll see how Neo did while I was away, probably bite the bullet and buy the paper and see what I want to do after.

Either way, I'm gonna do home testing and switch him to all wet food once I'm back! I just filled out my declaration forms for my pet insurance (I got it for both of my cats just before we found out Neo was diabetic so I'm really hoping they will pay for some stuff!) and yowzers! Our vet bill since May is ... well.. embarrassingly high. :shock:

 

You should definitely get more input on this, but the paper my vet gave me to read said that hypoglycemia was less likely in cats on Lantus, because it is longer-acting and causes less of an immediate steep BG drop. I'm sure nobody would recommend dosing insulin without hometesting, no matter what the insulin is, but it seems to me that Lantus is supposed to be among the safer and more gentle of the insulins.

I know it adds an additional layer of complication that you are looking to make all these changes just before going out of town, though. I don't know which is more dangerous--being in the early stages of a switch to Lantus without testing, continuing on the caninsulin without testing, or letting the cat continue with high blood sugar for such a long period of time.

I'm hoping someone else will provide an informed opinion because again, I don't really know what I'm talking about... I just remembered that tidbit from the article the vet gave me.

 

Do you show her the copy of the article from 2009 that I gave you yesterday? It point blank states:

However, I'll email you some more studies on Caninsulin if that's what she wants. Honestly, she should be the one doing the research but if this is what it takes, then go for it. EDIT: I don't want that to sound like vet bashing--she's willing to entertain the research and ready to educate herself, which makes her a keeper in my book.

Definitely take her up on her offer to prescribe the Lantus. Caninsulin (porcine lente) has been shown to have a 25% or less remission rate, while Lantus was shown to have 85-100% remission rate in newly diagnosed cats.

As for switching before your vacation--I hope others will comment to this, but I think that doing a diet change and shooting a lower dose of Lantus before you leave would be safer than your current treatment. My reasoning for this is that Lantus offers better glycemic control, and if you do it right away you'll have 2 weeks of testing before you leave to settle on a safe dose to shoot while you're gone. Is there any way possible you could convince the lady watching him to test him twice a day? Perhaps with a bonus if you're paying her or a gift if you're not? My boyfriend refused to help test Bandit in the beginning, but after he saw how easy it was for me to do it, and I started bribing him with dinner, he came around. Maybe you could give her a demonstration and see if it changes her mind?

Also, cats under stress and missing their owners sometimes don't eat properly, so one big concern I have with not changing is that it would be very dangerous if the Caninsulin was administered and he wasn't eating right.

 

One more thing...here's a quote from the AAHA Diabetes Guidlines:

 

I did show her the article and she seemed more impressed by the fact that I was doing some research myself (leaning a lot on you guys!) than what was in the article. And she was telling me that Caninsulin had just as much chance of remission as Lantus, so that's why I'm looking for Caninsulin articles. And not ones that compare it to Lantus either, because her first reaction to seeing the article was, "That was probably sponsored by Lantus."

I'm not hopeful about getting the lady to test him twice a day, but I can definitely ask. She struck me as a bit on the timid side about the insulin shots. She told me she's had diabetic cats there before and had no problems, but kept asking me how Neo was about getting his shots - did he struggle or bite or whatnot. Then again, I guess I'd like to know that as well. But I can't afford to pay her more - I'm already paying over 600EUR for her to keep our two cats while we are on holiday. And that's with me bringing all of the supplies (food, medicine, needles, emergency syrup, etc.) too!

To be honest, I'm more worried about changing everything around on Neo when I'm not going to be around than keeping things the way they are. It's just too much of a big scary unknown to me at the moment, and this is still too new to me to really be comfortable arguing with my vet. :cry:

I see you just sent me some articles. Thank you so so much! I'm going to read these over the weekend, do some home testing and have a good talk with my husband while I nurse my wounds (although I hope Neo won't get too mad at me). I guess I'll also have to hunt for stuff in Dutch as well. One of her other comments to me was, "You know there's a difference between the US and Europe...." Don't see what scientific point that makes, but I couldn't think of anything to say. Maybe I'll get him to call and talk to the vet for me - at least he'll be talking in his own language. That definitely makes it easier to argue! Thank you again! I'll get busy reading.

 

There is only one study (I've attached it) that shows a similar results with Lantus and Caninsulin (As opposed to many others that say differently), but in my opinion it is very unreliable and I'll explain why. In this study, insulin was only administered once a day for both cats. Because cat's have very fast metabolisms, dosing once a day is not effective for good glycemic control for either insulin. That's why comparing the results of the 2001 Caninsulin study and the 2009 Lantus study is more accurate.

The 4 cats that achieved remission probably did so largely as a result of the diet change. We see here sometimes that a few lucky cats achieve remission with diet change quickly despite their glycemic control prior to the diet change.

 

Thank you so so much, Julia! I'm in awe of all of these articles you have found - I was searching all over on Google and all I could find were forums, which my vet made clear to me she didn't consider a reliable source. Thank you!

 

Have you ever used Google Scholar? http://scholar.google.com/schhp?hl=en&tab=ws

I think I live there sometimes.

 

I'd never even heard of it! Heading there now - thank you!