? 02/02/2023: is Missy diabetic?

I'd like to introduce MISSY, my 14+ yrs old female calico cat to this group as it appears to me that she may be diabetic.
Missy has IBD since she was little (2010) and switch to raw meat diet around 2011 (started with Alnutrin supplements and switched to EZ Complete over 5 yrs ago) wich totally helped with her GI issues. After trying different meds, we settled with Budesonide (started with .4ml once daily and now down to .15 ml; through the years we tried several times to slowly eliminate Budesonide but we couldn't so I'm continuing with the .15ml dose. She's also taking supplements like pro/prebiotics, soluble and insoluble fiber, Omega3 fish oil, CBD oil, Assisi Loop (recently started when needed and seems to help with arthritis), Cerenia, Slippery Elm Bark and recently we added Milk Thistle as her ALT values went up.
Overall, except for her scarse appetite (acts hungry and demand food often times a day but she's picky and difficult to feed- she's also a very emotional cat and likes the attentions from me), I think her IBD is well controlled but looks like CKD and Diabetes are just around the corner.

After the experience with Micio, I started testing Missy on Dec 2021 and, trough the last year, she suddenly started drinking and peeing a lot; her Glucose numbers raised to a concerning point to me. She went from a low 90-100's to now a pretty steady 140+ (sometimes less). I do test her in between meals (at least 2 hours after meals) and whenever she lets me..
I looked back at all of her blood work through the years and noticed her BG's has never been the lowest but definitely under or around early 100's.

Unfurtunately, in the last couple of years, most of the attentions were concentrated on Micio as he developed multiple diseased but now Missy is the only fur kid in the house and going to do anything I can to take care of her health issues. She's definitely enjoying all of the attention from me already and hopefully that will reduce the stress accumulated through the years.

I am attaching her latest bloodwork from 12/21/2022 and would love if someone could please take a look and help me understand her health situation. Our current vet doesn't seem to be concerned and probably won't take any course of action 'till is too late. Next, I am going to look for a different vet and possible Internal edicine specialist.
THANKS IN ADVANCE FOR ANY SUGGESTIONS.

 

Hello Simone I will take a look at the bloodwork now.

 

There's a lot to be happy about in that bloodwork. It's really not a bad bloodwork at all for a cat of her age. Hematocrit good. Creatinine still good. BUN just barely out of range (and that can fluctuate.) She seems to be just borderline in the fructosamine / BG area, don't you think? Do you have a spreadsheet for her? I think it would be good at this point to just get tests in on her (I know you already started) and track them on a spreadsheet. You already know how to do this very well.

Her urine specific gravity is low, so she's not concentrating urine as well as would be best. But you already know this. Her urine pH is good. No protein in the urine, no ketones, all good.

The ALT is just barely high. When did you start the Milk Thistle? How long before this blood was drawn? Or was it after the blood was drawn. My vet would say not to be concerned about an ALT of 106.

Low lymphocytes are caused by the Budesonide. You can't stop the Budesonide as you already have said, so don't worry about that. Her SDMA is still okay. Her thyroid is fine according to that T4. I think you are doing everything right at this point and should just get her rechecked in 3-6 months if she seems stable.

If you start up a spreadsheet for her and input some of the numbers that you have for her, then we could take a look and see if it is possible that Missy needs a tiny bit of insulin support?

Have you thought about the possibility that any of her medications or supplements are making her drink more or peeing larger amounts?

 

I do think it would be a good idea to get an internal medicine vet on board to take a look at Missy. They can be good at helping manage multiple medical conditions.

 

I’m not much help on lab work but just wanted to jump in and say I was worried Bobo was diabetic when he started drinking and peeing a ton. I tested him and he was within the normal range so after a senior blood panel and ultra sound it was confirmed he has CKD. Since you mentioned CKD, it also causes a ton of drinking and peeing since their urine is not concentrated enough anymore.

 

Back last May's bloodwork, Missy had some blood and protein found in the urine; forgot to mention I also request a culture which turned out NEG.
Her ALT had always been good, exept for this last time. I started with only 50mg milk thistle once daily for now (but will increase a bit soon) after the latest bloodwork in December. I was giving Micio milk thistle and Ursodiol for many years and finally just recently his ALT was good (when I first took him in his ALT was more than 500!)

I haven't change any medication lately other then lowering the Budesonide and I'm "hoping" that recent stress in the house was something to blame.

Going to start a spreadsheet for Missy soon. Thanks for your time and thought

 

I'm actually more concerned about her kidneys....this is Antech labs comment on the last results and it scares the hell out of me. Missy is not a "normal" cat that will accept any treatment easy at all if none!