Another cat with raised glucose levels, diabetes or else?

[Lisa and Angel]

Hi all,

I've been here before with Angel; she's still doing well on Lantus, no concerns there.

However... I'm here about one of my other cats. His name is Sir Cat, he's a 15 year old Maine Coon. He has severe arthritis, had a kidney infection which caused acute kidney injury in 2023, has CKD (I think stage 1) because of that, megacolon and hypertension. And now, maybe also diabetes.

Sir Cat is slightly underweight, not taking corticosteroids, and does have a history of UTI's, so I'm "hoping" it's just that. He gets about 8 (mostly LC) wet food meals a day, but does have HC kibble to snack on in between and at night from his surefeed to keep his weight up.

For the last few weeks, he has been very vocal, very hungry and very restless. He's also losing weight at a slow but steady rate. I'd already booked an appointment to get him checked out which is next Monday, so that's already happening. I honestly figured he's probably hyperthyroid, as he seems like a classic case. Not great but not horrible either; both Angel's sister and mom have hyperthyroidism, and that's much easier to deal with than the other common chronic illnesses imo.

I regularly check his urine with dipsticks to get ahead of any urinary issues. They're OTC dipsticks but very reliable. It's nice to just get a test in when I'm worried, especially since his megacolon/constipation issues sometimes cause him to meow in the litterbox, and I'm still slightly traumatized by his earlier kidney infection and a urinary blockage in 2022. Point is, I tested his urine 10 days ago and it was perfectly normal. No glucosuria.

He's been out of wack today. Wouldn't eat his breakfast, completely unthinkable for him. Lethargic and just not looking right. He's eating again now but still looks off. So I decided to get another urine test in. And whaddyaknow, the glucose patch changed color. I test again with a new dipstick and yeah, same result. +2 for glucosuria. No pH changes, no blood in his urine, minimal protein (normal for him).

At this point, I'm cursing. And then I sigh and set things up to check his blood glucose. It was a bit of a struggle as he's very much a "touchies only on his terms" cat, but we got it done. 7.8/140 glucose. Not terribly high but higher than normal.

After freaking out for a bit, I decided to come here and post for help. What do y'all think? Very early caught diabetes? Temporary elevation? Maybe a UTI? Could a regular illness cause stress causing elevated glucose, or would that not immediately spill over into the urine? Is prediabetes a thing in cats?

This boy already has so much **** to deal with. His arthritis is extremely advanced because he has a super rare bone deformity. He has the joints of a 30 year old cat. I know in my heart this will be his last winter as his quality of life has been steadily declining over the years, and he's been on and maxed out on every single available pain med, including off-label and experimental ones. I was hoping we'd have one more summer together. I know diabetes isn't a death sentence, but I don't know how much more he can take.

I'll be testing him again tomorrow, and checking ketones as well. Then vet time on Monday. Eager to read your comments, and will keep y'all updated.

 

[Bron and Sheba (GA)]

I'm glad you are checking for ketones. That was going to be my first question and then you answered it in the last line!
Have you actually checked for them yet?.
I don't like to hear of any cat being lethargic.
Can you cut out the high carb dry food and replace it with one of the low carb ones? that would be a start. Oh if you are in the Netherlands you probably can't get the low carb dry. What about the freeze dried foods? Can you get those?
I would ask for a fructosamine test as that will give you the last 2 or 3 weeks BGs and will tell you if he has diabetes. It does sound as if you have caught it super early if he does have it.
What are you giving for the arthritis?

 

[Lisa and Angel]

I'm glad you are checking for ketones. That was going to be my first question and then you answered it in the last line!
Have you actually checked for them yet?.
I don't like to hear of any cat being lethargic.
Can you cut out the high carb dry food and replace it with one of the low carb ones? that would be a start. Oh if you are in the Netherlands you probably can't get the low carb dry. What about the freeze dried foods? Can you get those?
I would ask for a fructosamine test as that will give you the last 2 or 3 weeks BGs and will tell you if he has diabetes. It does sound as if you have caught it super early if he does have it.
What are you giving for the arthritis?

Have not checked for ketones yet, no. Haven't gotten a big enough blood drop from his virgin ears yet but I'll keep trying.

I can cut out his HC foods, dry and wet. It would be absolutely awful, but it could be done. I'm just not sure if it's in his best interests to do so. He's basically terminal because of the arthritis, and this is supposed to be the time in his life where he'll get anything and everything his little heart desires in terms of food (excluding anything dangerous ofc). Many of his favorite foods are HC. I'm hoping it'll be something else so this won't be necessary.

We do have some low carb dry foods here, but they're all incredibly high in phosphorus, not a good idea with his CKD. Plus, from what I can remember he didn't care much for the taste while I was trialing them for Angel. I don't believe we have freeze dried foods here, beyond single protein snacks. And that's apparently kinda dicey with the H5N1 situation too.

Yeah, I'll ask for fructosamine tomorrow. I just tested him again and he's 8.4/151 now. Gave him some HC food and will attempt another test in an hour to see if he'll react to the HC food.

For the arthritis he's currently on Solensia and Tolfenamic Acid (a strong NSAID, off-label use).

 

[Bron and Sheba (GA)]

If you want to continue with the higher carb wet and dry food we could work around that with a higher dose of insulin if it turns out he is diabetic and you don’t want to take away the food he enjoys for the time he has left to enjoy them.
Sounds a beautiful boy.

 

[Lisa and Angel]

If you want to continue with the higher carb wet and dry food we could work around that with a higher dose of insulin if it turns out he is diabetic and you don’t want to take away the food he enjoys for the time he has left to enjoy them.
Sounds a beautiful boy.

Yeah, that's certainly a very attractive option. I wouldn't be too thrilled about another cat on insulin, but it might be the least impactful choice for him, depending on how he'd take to shots and frequent testing.
And thank you! He's my gorgeous dude. A very distinguished gentleman.

Btw, another test (and bless my sweet boy, he's taking this all like a champ) revealed a glucose level of 5.8/104 and I also managed a ketone test, which was only 0.1 which is great!

 

[Sienne and Gabby (GA)]

Lisa --

If you're concerned about Sir Cat's weight, you might want to look for a higher calorie, low carb food. There are likely foods that fit that combination. This is our UK food list and it does have information on calories (seee the 6th column). I'm not sure if all of the foods are available in the Netherlands but at least it's a start.

It's possible that if he's having an arthritis flare that his blood glucose level would bump up. Any sort of inflammation or infection can have an effect on the numbers. I hope he starts feeling better. He's a gorgeous cat!

 

[SmallestSparrow]

The species I treat walks upright so this may not apply at all but some patients with kidney damage have glycosuria because their kidneys don’t filter correctly, not because of diabetes.

ps what a very handsome guy!

 

[Bron and Sheba (GA)]

He is certainly a handsome gentleman!

 

[Lisa and Angel]

Thank you Sienne for the food list! If we do need to go off kibble, I'll be sure to check that for the highest cal wet foods. I don't mind him being on the lean side since it's better for his arthritis, but he definitely doesn't need to lose any more.

And thank you all for the compliments! He loves to hear how handsome he is

Since a few hours ago, Sir Cat has been feeling pretty miserable. Sitting hunched over, zero appetite once again, vomited white foam twice, and has been drooling (nausea). I'm thinking possibly pancreatitis? Would explain the glucose as well (fingers crossed it'll be temporary). Not dehydrated based on skin turgor. I just tested him and he's now at 9.8/176, the highest he's been so far. Can't wait to go to the vet tomorrow to get some answers and some relief for this poor boy.

 

[Bron and Sheba (GA)]

Poor boy. I could be pancreatitis.
I hope the vet visit goes well tomorrow for you both.

 

[Diane Tyler's Mom GA]

Hi Lisa ,Sir Cat sure is a gorgeous dude. I hope the vet visit today goes well and you get some answers so he will start to feel better. Poor baby.
Please keep us updated

 

[Sienne and Gabby (GA)]

In case you need the info, this is our Primer on Pancreatitis.

 

[Lisa and Angel]

Hi all,

Yesterday he was feeling good again. Still, we had our vet visit late that afternoon. Had some bloodwork done which showed nothing super exciting. Glucose was a tad high (180s) but not diabetes numbers according to vet. Said fructosamine probably wouldn't show anything yet, and this was likely from stress/inflammation from whatever illness he's got. Kidneys looked great. T4 looked great. Nothing immediate jumped out as a diagnosis for the ravenous hunger and weight loss.

On physical exam, his belly apparently felt very hard and round. Vet said it was full of air. Said he's probably swallowed a lot of air down when he was feeling so nauseous. She couldn't really palpate anything in his belly because of all the air, so we were given Metoclopramide to give at home. Anti-nausea and prokineticum to help the air move along. One quarter of a 10mg tablet.

I gave him this in the evening, a few hours before going to bed. When I was getting ready to go to bed, I noticed him trembling/shivering a bit. Almost like a spasm. I looked up the information leaflet online (not sure if this is the correct translation from my native dutch "bijsluiter", but it's what google translate is giving me, so) and saw that the dose he was given, is only supposed to be used in patients over 10kg. He is only 4.3kg. Side effects do list tremors as a possibility, among scarier ones, and the overdose section only said that the listed side effects are more likely and that there is no antidote and would wear off on it's own. So I went to bed, set my alarm for 6 hours later, and slept a bit.

When I came downstairs this morning, I discovered a huge pee puddle in the middle of my living room. Of course I checked on Sir Cat first. He was asleep in one of his cave beds, but responded when I greeted him though he did not get up and exit his cave. I assumed the pee was from Angel (she had a UTI recently which gave her some bad habits) and cleaned it up.

While getting Angel's insulin ready, Sir Cat literally crawled out of his cave. And collapsed on his side. He couldn't get up. His backside was wet with pee. It was his pee on the floor. Sometime during the night he laid there, while I was blissfully asleep upstairs. I feared for a saddle thrombus but he wasn't paralyzed, had full sensation of all limbs but no strength or muscle control. Paw pads were warm and pink. Pee dripped out of him at a steady rate. I immediately called the vet and raced over there.

The vet predicably denied that she overdosed Sir Cat. Even though the med itself says this is for pets over 10kg, and there's a lower dosage available for 5kg pets that I believe we should've gotten. But agreed that he clearly wasn't responding well to it. His bladder was extremely full, so she manually expressed it. And said that if this is from the drug, it should wear off soon. But she didn't believe it was. She thinks it's some kind of neuropathy. But there's no easy way to diagnose that and when you do have a diagnosis, there's probably no treatment either. So we should just take him home and hope for the best. So that's what we did.

It is now 25 hours after administration of that tiny little pill, and he has not improved. My mom thinks the culprit is Solensia (his last shot before this one was 6 months ago, he got this one 12 days ago) because she's been reading a lot of Facebook horror stories about it. I'm not sure myself. I gave him prednisolone an hour ago, as a last ditch effort, because there's no improvement at all, so it's probably not just the pill from last night causing this anymore. No motor control, no bladder control. If you pick him up and set him down, he doesn't put his paws down properly (knuckling), tries to walk a few steps but then just falls over. His bladder fills up and overflows so he's dribbling pee on himself, so I have to manually express it every few hours. And he just lays down, legs still spasming every now and then, and cries pitifully. He hasn't drank or eaten anything at all today. He looks like he's given up. If he has not improved by tomorrow morning, I will set him free from his suffering.

I genuinely cannot believe the reality I'm living right now. He was fine yesterday before we went to the vet. My mom even said she didn't think we needed to take him at all, but I wanted answers about his hunger and weight loss. Now I think, maybe I was just spoiling him by giving in every time he wanted wet food, and teaching him that he could get it on demand whenever he meowed for it (which was true). So he got more and more. And maybe the weight loss was just him having more wet food than dry, and eating less calories as a result thereby losing weight. Idk. I think I'm numb right now. I just hope he'll magically get better tomorrow but my heart is heavy and his eyes look like he's stopped fighting.

 

[Diane Tyler's Mom GA]

Oh Lisa I'm so so sorry this is happening to you and Sir Cat . I'm saying a prayer tonight for him to wake up feeling better and you see some improvement.
My heart just breaks for your handsome boy .
Please keep us updated

 

[Wendy&Neko]

Do you have an emergency room vet you could take him to? Besides diabetes, other conditions that can cause weight loss in spite of a good appetite are GI conditions like small cell lymphoma and IBD.

 

[Lisa and Angel]

Thank you both for your comments. With my greatest sorrows I announce that Sir Cat is flying free now.

He did not improve overnight. He got worse. No strength to even move around anymore, became terribly dehydrated, didn't want to be touched, and clearly so uncomfortable. So I called the vet at 8 to book the euthanasia.

The earliest availability for at home euth was at 10:30, so I booked that. Unfortunately, Sir Cat went into respiratory distress at around 8:30, so we tried as fast as we could to get him to the vet instead. He died in the car on the way there. I held him in my arms as he passed. He was scared and panicked about the car ride, and I believe his heart gave out. I feel indescribably horrible that he died feeling so frightened in his final moments, in a moving car instead of at home or safely and controlled at the vet, but I don't think he would've made it to 11am. He was panting and gasping for breath and getting worse by the minute. His actual death was over very quickly.

I've never experienced a natural death from one of my kitties. Only (planned or emergency) euthanasias. I'm not sure how I'm feeling right now. Of course I'm grieving but I'm also secretly relieved that he's finally free from his suffering.

 

[Diane Tyler's Mom GA]

Oh Lisa I'm so saddened to hear this
This actually has me crying. You did all you could to get him to the vet quickly
He was such a handsome boy
He is now at peace. You will never be forgotten Sir Cat. Please take care Lisa

 

[Wendy&Neko]

Oh no, I am so sorry to hear this sad news.

Fly free Sir Cat.