? low appetite cat + diabetes = even lower appetite, second shot woes

Before the diabetes my cat had a pretty low appetite to the point she has been on an appetite stimulant for the past 2.5 years. Since diabetes her appetite has gotten even lower likely due to the increased thirst.

She has been a grazer for 12 years and I've worked with behaviorists and vets and she just won't take to a clock based scheduled meal system. She eats when she wants to eat and that's that. She likes to eat tiny amounts (think a table spoon of kibble) every few hours. If I try and make her wait she'll just skip that meal and won't be interested in food until the next one (3-4 hours later).

How do you deal with the second shot and a cat that you can't get on a clock-based feeding routine? Do I just not give her that second shot most nights? Or do I just give her the shot regardless of when she eats because it's likely she has eaten 2 hours either side of the shot and maybe that is "good enough." Even on days I can get her to eat before the shot, it's usually not much...maybe 0.2oz by weight/scale (not liquid/cup based) if she was HUNGRY. Some days I give her another dose of appetite stimulant 45 minutes before the second shot time but it doesn't always work on days she is being extra difficult.

Testing her bg is out of the question. The vet needed two techs to hold the cat down to do it the other day. I've tried to do it once and the cat hid for 5 hours our of fear. So based on the advice of our vet and behaviorist I'm not going to try to test her for fear of turning the cat off from me (which both the vet and behaviorist have seen with bg testing specifically).

I appreciate any insight you have.

 

I am not a fan, in general, of the Libre continuous glucose sensors, but in your case, I would consider using the Libre sensors to keep her safe.

 

As for BG testing “turning off” cats from their owners, that’s a bunch of bunk. Maybe the people they (the vet and behaviorist) are talking about aren’t doing it correctly or haven’t really tried beyond the first few attempts, but we have many many members here (now and over the years) who were told the same thing by their vets and it simply wasn’t true. If anything, a special bond is formed between the cat and the owner like no other. It’s true that some cats have a limit to the amount of testing they will permit in a day, but if you train the cat to have its ear tested and appropriately reward it with treats, they will accept ear BG testing. There are very few exceptions to this and perhaps your cat is one of them. Your Missy also doesn’t seem to be food motivated at all. The only way to keep a cat on insulin safe from hypoglycemia is through home testing with a handheld meter or with a Libre sensor. Your cat does sound like a challenge and I can tell that you are doing your very best to help her. I am sorry that this additional challenge of diabetes has been added.

 

If you are feeding her only kibble then please try to get her to eat Dr. Elsey’s Clean Protein kibble. The chicken flavor is the lowest in carbs. There are only two kibble on the market currently that are low carb, which diabetic cats need — Dr. Elsey’s Clean Protein and Young Again Zero Mature. It’s not ideal, because a low carb wet food diet is the ideal diet for diabetic cats, but it’s better than a high carb kibble such as the junk many vets try to sell their clients (“glycobalance” and DM dietetic management not diabetic management.).

Having said that, if transitioning from high carb food to low carb food, be very careful that Missy’s BG is being carefully monitored by you or by a Libre sensor because low carb diets really do lower blood glucose and we definitely want Missy to be safe.

How many units of insulin are you giving her now? Is it still 1 unit? How are you managing to give her the shot of insulin if she won’t tolerate BG testing and his for five hours? What BG numbers has the vet gotten on her? Have they run a curve?

 

Thanks @Suzanne & Darcy! A couple of replies to your posts

Libre sensors - That is something to consider, I will ask my vet about that.

"turning off" - I'm just saying what two independent cat experts have told me. I understand the mileage on this forum could be different. Like everything cat related, it all depends on the cat. She is the opposite of food motivated so treats don't work because she won't eat them (never has, even the temptations treats). The cat and I already have a strained relationship due to her lack of interest in food and me having to stay on top of that. She really does not ever want to eat and I have to really coerce, coax, and damn near force her to eat because otherwise she won't. Before I had to get involved and before the appetite stimulant she was only eating ~100 calories a day of food. This is partly why she is on a kibble diet...not only did she not really like wet food but when I could get her to eat it she would only eat a tea spoon at a meal and with wet food being so calorie deficient that became a real problem. I think she needed ~7 ounces of wet food a day but I could never get more than 2 ounces in her and that was fighting her the whole day at each meal.

"food" - yes she eats a prescription kibble for UTI problems. She's been on this food for the bulk of the past 12 years and the two times she went off it (a different story for a different day) her UTIs came back almost immediately and kept coming back until we got her back on the food. It is unlikely she will be off this food or some rx UTI food.

Insulin - she still gets 1 unit twice a day. The cat eats around 15 times a day so when the clock says it's second shot time she has eaten within the past two hours and she will eat again sometime in the next two hours...she just might not eat right now when the clock says it is shot time. The second shot's time flexes a bit based on when I could get the cat to eat. If second shot time is at 7 and I can get her to eat in the 6 oclock hour I'll just shoot at 7. I figure that's good enough because that is the absolute best I can do. If she hasn't eaten in that 6 oclock hour then I'll just wait a bit on giving her the shot because she is likely to eat in the 7oclock hour. Some days I spend an hour or so trying to get her to eat around second shot time, playing with her, giving her pettings, carrying her to the bowl, the whole works to just get her to eat. I've also resorted to giving her an additional dose of the appetite stimulant if it's around second shot time and she's not wanting to eat...that will normally guarantee she will eat SOMETHING within the hour.
We go to the vet in four days to get a BG test. They have not done a curve and that is unlikely because of the cat's disposition. My girl really doesn't tolerate going to the vet well (she won't eat/drink/sleep while she is there) so we will probably just to spot-check BG tests once a week. The cat is not very cooperative and so doing routine testing is out of the question, changing the food is out of the question, changing meal times is out of the question...I'm thankful she tolerates the shot because of how difficult it is to get liquid or pill medicine in her (takes two techs plus the vet to pill her, I can't do it).

 

Oh my goodness. Just reading all of this is overwhelming. It sounds like you are doing your very best. I suppose you spent years searching for the cause of her low appetite. It’s strange because normally cats with unregulated diabetes have a ravenous appetite. She has the opposite. I hope you can get to a dose that will help her with symptoms like the excessive thirst, but will not bring her low enough to be anywhere near dangerous. If you are going to take her in for a BG spot check, try to make it at around +6 (six hours after her shot time to maybe catch her nadir) — just a thought since what’s most important is how low the dose is taking her.

I feel really badly about how difficult this is. As for sometimes having to shoot an hour late or so, I think it’s fine. We have a couple of members who can’t shoot ProZinc every 12 hours due to work schedules. Some shoot at 12 and 14 hours (which makes the next shot at ten hours - of course they are BG testing on their days off - running curves.) In your situation, if you shoot an hour late would you be able to do the next shot 12 hours later — or perhaps 11.5 hours later? Do you have the flexibility to get shot time back on track? It’s best to have some food on board at shot time. If it’s a small amount that is okay as long as she’s going to eat something within the next two hours (also can be small amounts.) Grazing through the cycle is okay in her situation, too. Since you can’t test, there’s not much point in withholding food for two hours prior to shot time, since the purpose of withholding food is to make sure the BG is not too low to shoot.

I guess getting some gabapentin into her prior to vet visit to relax her is not possible either? It really can work wonders to relax them and take the stress out of vet visits. I have recently discovered that, in one of my cats, a low dose of Gabapentin (about 25 mg.) increases her appetite. It actually works better than Mirataz (which I also give every other day.). She’s a compliant cat though so I have no problem pilling her— which is good because she takes so many pills for her heart daily. She absolutely is supposed to have Gabapentin before vet visits at this point (even though she’s always been pretty good at the vet) because she’s not supposed to get stressed out due to her heart condition.

Missy is lucky to have such a dedicated caretaker as you!

 

@Suzanne & Darcy Yeah, I live alone and there is no way I could give her a pill by myself. She is just a fighter. She is a great cat -- very snuggly and affectionate -- but she has clear boundaries and if you cross them she gets very upset lol.
Regarding shooting late, if I did have to shoot her late, I'd probably do the next morning shot at 11.5 hours to try and keep it at our idea/best time of 7am/7pm. That's the clock schedule we strive for b/c it makes the most sense even if our best isn't that great. It's all we can do. I'm hopeful that because she grazes that her bg will just never be too low to shoot since I really can't test her. She BARELY lets me put the mirataz on her ears and some days I have to physically restrain her to do that. But with the shot she doesn't mind, go figure. Her eating varies so much and to make that 7pm meal stick we really start preparing before noon to try and get her meal cadence in sync to just allow that 7pm meal to happen...it's literally an all day thing. She has occasional days when she just "fasts" after breakfast until the next day and those days tend to be obvious and those will be no pm shoot days.

 

In your case, a Libre might be a good option, as long as she will tolerate it. There’s a Facebook group for people who put their own Libre sensors on their cats and it has all kinds of tips for putting them on and what kind of adhesive to use, etc. It’s a lot less expensive than taking a cat to the vet to do it. Many people put a little shirt on their cats to cover it. I am not a member of that group, but I have heard people here talking about it.

 

I'll ask my vet about it tomorrow and see what she has to say. I'm hesitant against something like that b/c in the past the cat has hated having anything foreign on her. She flipped out when we put a normal cat collar on her.

 

I was afraid of that!

 

A few years ago she was constipated and the vet suggested this thing called catlax...it's a lickable deal you can put on their paws and they'll lick their paws clean and get the medicine in it. It's normally used for hairballs but can help with constipation. I tried that on my cat and she freaked out and went running and hiding all over the house trying to get it off. I'm still finding bits of that material in dark places.

 

Wow.