New member- advice on treatment options

Hello! My name is Julia and my 8 year old male cat, Nathaniel, was just diagnosed yesterday on 11/13/24. The diagnosis was a complete shock as Nathaniel has not exhibited any abnormal behavior. There have been no changes to his drinking, eating, and litter box habits and he continues to have energy and be playful with his sister (Ophelia). Below is a timeline of events leading to his diagnosis.

8/15/24: I took Nathaniel to the vet for an annual check-up, where he weighed 15.6 lbs. Since leaving this appointment, in an attempt to get Nathaniel to lose weight, I cut back his food and separated him from Ophelia's food (as she likes to graze and Nathaniel would eat whatever she left in her bowl).

11/7/24: Nathaniel went back to the vet for bloodwork as he was scheduled for a teeth cleaning in December and would be under anesthesia. At this visit, he weighed in at 14.4 lbs (so he lost 1.2 lbs in 3 months). His weight loss could very well be the first/only symptom, but as I mentioned I had been intentionally trying to get Nathaniel to lose weight.

11/11/24: Vet calls with bloodwork results. High Glucose levels (384 mg/dL) along with abnormal electrolyte levels. The vet said these results could be due to stress, so she recommends a Fructosamine test.

11/13/24: Fructosamine comes back high (594 μmol/L). Nathaniel is diagnosed with diabetes. He needs to go back to the vet within the next week for a urinalysis.

The vet prescribed a high-fiber food called W/D (Nathaniel has not yet started on this food). Has anyone used W/D food before? What are your thoughts on it?

The vet recommended two treatment options: twice-daily insulin injections or a once-daily pill (Bexacat). She said Nathaniel is an excellent candidate for Bexacat as he is otherwise healthy and has never used insulin before. My concern with Bexacat is that it's such a new treatment and seems to have side effects that can lead to serious problems (diarrhea, increased risk of UTIs and ketoacidosis, etc.). But if Bexacat doesn't work, there's still the option of switching to insulin. I know the benefit of insulin is that it's a tried and true method that vets have a lot of information and experience using, and is typically highly effective and some cats can go into remission with insulin. But going straight to insulin means eliminating Bexacat as a treatment option. In your opinion, is Bexacat worth trying? Is there a chance of remission with Bexacat? Or would it be better to go with insulin?

Thank you in advance for any suggestions/input!

 

Welcome to you and sweet Nathaniel.

It looks like your vet did the right things with the blood test and the fructosamine, but missed the ball on the food choices. High fiber might be how you treat diabetic dogs, but not cats. What is important for cats is lower carb food, which usually means higher in protein. The W/D is horribly high in carbs. Frankly, none of the available "vet" foods are much good at treating diabetic cats and too high in carbs.

Most of us feed off the shelf foods with lower carbs, under 10% carbs. This food list gives you a list of some of the common ones, and lists their percentage of carbs. Does Nathaniel eat wet or raw food? What food is he eating now? Low carb food is best whether going the insulin or Bexacat route, and should be a life time change for him. Some cats do well with just switching to low carb food, but not if there are ketones.

Did your vet mention anything about ketones on diagnosis? Did the urinalysis show any ketones? Have you read this post: New Treatments for Feline Diabetes
Whether you go Bexacat or insulin, you will need to learn how to test for ketones. You can either get a blood meter to test ketones or uninary ketones strips. Tips to catch and test a urine sample

Did the vet mention which insulin they'd recommend?

 

Thank you for your response! I appreciate the warning about the W/D food and the link to the food list. Nathaniel currently gets 1/4 cup of Purina Pro Plan (Adult) in the morning and right before bed and 1.2 oz of Tiki Cat wet food for dinner. He has not went in for the urinalysis yet, I am trying to get him in asap early next week. I did read the post about new treatments for feline diabetes. From what I read/researched, it sounds like if there ends up being ketones in his urine then insulin would be the the best treatment option as the presence of ketones would increase the chance of Bexacat side effects. So I guess the results of the urinalysis would dictate which treatment option is best? I just don't know if the Bexacat is even worth trying given the potential side effects and knowing insulin is a proven treatment that could even result in remission. It seems the only benefit of Bexacat is that it's a daily pill vs. insulin injections twice a day, but I want to do what's best for Nathaniel and not what's easiest for me. I left a message for the vet this evening asking which insulin she recommends, I should hear back tomorrow and will update.

 

You can test for ketones at home with Ketostix, or equivalent ketone testing strips. If treatment is going to be delayed at all, I'd test at home. Unfortunately, we've seen a couple people here whose vets put them on Betacat when there were ketones at diagnosis, with unfortunate results. Insulin is not just the best option, but the only one if ketones are present.

We have seen a few members here with kitty's on Bexaxat or Senvelgo (liquid version) and doing fine, but unfortunately not many posting other than the beginning to let us know how it went.

Any chance Nathaniel could be switched to just the Tiki and ditch the dry food?

 

You mentioned that Nathaniel's labs showed that his electrolytes were off. That could be an indication of ketones developing. I would pick up some Ketostix like Wendy suggested and see what the results indicate. I also agree with her suggestion about ditching the dry food and sticking with the Tiki Cat or another low carb, canned food. Dry food is typically extremely high in carbs.

If you end up going with insulin, the American Animal Hospital Assn guidelines recommend either Lantus (glargine -- it's now available as a generic/biosimilar) or Prozinc for treating feline diabetes.

 

Thank you both! I’ve switched Nathaniel to wet food only (Tiki Cat and also introducing Fancy Feast Chicken Pate) and I’m keeping his carb intake at 9% of his total daily calories (between 200-240 kcal as he still needs to lose weight- he’s 14.4 lbs and he should be around 12/13lbs). The earliest the vet can see him for a urinalysis is next week Thursday, so I will definitely pick up Ketostix in the meantime and try to test myself. I confirmed with the vet that if we were to go with insulin, she would prescribe him Lantus.

What’s still throwing me off is the lack of symptoms. Nathaniel continues to act totally normal. I worked from home yesterday and watched him closely- he peed in the litter box once, drank from his water bowl twice, slept for a few hours, played with our other cat, ate at his normal times and didn’t beg for food at any other point in the day. Nothing out of the ordinary. I guess it’s bc we caught this so early having done blood work for the dental procedure? The vet said most people find out about diabetes bc they notice behavioral changes in their cat and so they take them to the vet for testing.

 

I've seen quite a few people find out their cat was diabetic when it went in for blood work for a dental. You might have found it early, which is a good sign and makes remission more possible.

 

I used a Keto Mojo GK+ to test Nathaniel's ketone levels this evening and the results were .3. From what I've read, any reading under .6 on a human meter is fine. Even though his ketones levels are ok, since ketones are present in his urine, does this mean Bexacat/oral medication is no longer an option for treatment and he should only use insulin? I don't want to solely rely on the results I got during my first time doing this, so I will still take Nathaniel to the vet next week for a urinalysis so they can 100% confirm his ketone levels.

I am going to try to get a glucose reading in the morning.

 

I would not be comfortable having my cat on one of the new oral medications if there were ketones anywhere in the picture. We have seen some disasters when the vet ignored the recommendations about the presence of ketones.

 

Good morning. I've been tracking Nathaniel's meals, glucose, and ketone levels for the past few days on this spreadsheet. His glucose levels have been high the last two mornings, and then decrease after eating. Why would glucose levels decrease after a meal? I thought eating increases glucose? The glucose reading on the bloodwork he got on 11/12/24 was 384 mg/dL. I moved him to a low-carb wet food only diet on 11/15/24 and began tracking his levels on 11/17/24 with a Keto Mojo GK+, and his glucose levels have stayed below 280 mg/dL.

I am taking him the vet this Thursday for a urinalysis and to decide on a treatment plan (insulin or oral medication). Given the information in the spreadsheet and mentioned above, does Nathaniel have a good chance of going into remission if we start him on insulin (Lantus)?

 

Good morning, I am newer here so I will let more experienced members answer your question, but I just wanted to let you know that the link you put on "spreadsheet" takes you to a NC State Energy Commission website, not a spreadsheet. I really hope the best for you and Nathaniel on Thursday, he is lucky to have such a caring human!

 

Oops, thank you!! That's what I get for doing this on my work laptop I fixed it!

 

Lol I know the feeling! Your spreadsheet is really thorough and has a bunch of good info, hopefully someone more experienced will be able to give you a better idea about remission!

In the meantime, I'm gonna share the spreadsheet format they set me up with when I first got here, might be something useful you could use:

https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Hope you hear back soon and have a smooth vet appointment!

 

I might shed a little light. Bg will rise w eating then begin to decrease as the body release insulin in response. Also unlike humans cats don’t spike as dramatically. It looks like you’re testing 90-120 min maybe post meal (I didn’t go through entire chart) and so insulin is already dealing with the meal.

in addition, there is meter variation, usually as a percent of the value given. The alpha trak variation above 100 is (I think, sleep deprived now) 10%. I’ve heard some say human meters can be up to 20% or more. This is an accuracy variation meaning how close is the meter reading to what that sample would read in a lab. So 300 and 270 are essentially the same number. I give a tiny credence to trending up or down but at high numbers if within the allowable variance I don’t get too invested. I say this NOT as an old hand here—I’m new—but as a math nerd who’s bugged the heck out of engineers at zoetis and Abbott

 

Hi everyone,

I have a cat named Hobbes (8.5 years old) and he has been diagnosed with diabetes. We are in the process of increasing dosage to level out his sugar levels.

Last night, I checked his levels and it was in the 400's. He eats fancy feast classic pate and he is prescribed 2 units of prozinc in the morning and evening.

I checked his levels 2 hours after he ate, and his levels were in the 700s even after I gave him insulin. Because my vet was closing in an hour, they recommended I go to an emergency vet.

They did bloodwork and everything came back normal and they did a glucose curve. He has been discharged as of this morning and I am staying home with him as I know the trip was very stressful for him. His levels are in the 200s now and I am going to my regular vet next week so we can figure out a game plan to get his levels between 80-120. I paid $900 for this vet trip, and I am reaching out to seek some input and/or validation I did the right thing. Did I do the right thing of taking him to the emergency vet?

 

It would help us a lot more if we could see a spreadsheet. Without one we can’t really give dosing advice.
It is possible Hobbes is bouncing from dropping lower than he is used to. 2 units is a lot to start a cat on. We would recommend more like0,5 to 1 unit of insulin to start with. Will tag @Suzanne & Darcy for you as she is a Prozinc user
Here is information about bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

I would like to help. If you can start your own thread that would help (because this post is on someone else’s thread. ). Also, yes, I need to see spreadsheet data.

 

@Mhorb -
Could you start a thread for. yourself and your kitty? Having your post embedded in Julia and Nathanial's thread means yours will be ignored. We ask each member to have their own thread. Otherwise, it gets confusing as to who the people posting are responding to.

 

How do I create a thread??

 

Go to the main page for thos Feline Health Fprum and click on Post New Thread. I hope you can see it here in this screenshot I took.

 

@Suzanne & Darcy
She just posted her own thread
https://felinediabetes.com/FDMB/threads/hobbes.295985/#post-3223054

 

How did the urinalysis turn out and what did you decide on for treatment (if anything)? Any more ketone tests?

My vote would be for Lantus given the reference to electrolytes being slightly off, the presence of low-level ketones, and the fact that you apparently caught the diabetes early (which increases the chance of remission with Lantus). Oh, and also that guy said you want to do what’s best for Nathaniel not what’s easiest for you.

Changing to low-carb food can dramatically reduce BG but most cats need at least a short course of insulin (sometimes tiny doses) to have a strong remission.

Please let us know what you decided and how Nathaniel is doing.

 

Hi! Urinalysis results were great, no ketones. He also tested negative for pancreatitis. And still not showing any symptoms- Nathaniel continues to act completely normal! He’s been on a strict low-carb wet food diet for two weeks now and his glucose readings have been trending downward (now consistently below 200). I did end up taking him to another vet (who only treats cats) for a second opinion. This new vet said she would be hesitant to give Nathaniel even the smallest dose of insulin given his numbers and thinks diet change, along with losing another 1-2 lbs, will give him a great chance of going into remission. So for now the low-carb wet food diet seems to be working. I’ll still continue to closely monitor his glucose to ensure his numbers are holding, but if they do start to increase I will start him on Lantus.

 

Glad it’s looking like he’s on a good path!