Alright, so I haven't updated my chart in ages so I know you guys will get after me for that right off. The truth is, I use a little calendar to update Duke's chart, but I had a few months worth of those that I've somehow managed to lose and haven't been able to go in and update it. That said, ignore that for now and see if you can give me some other advice based on some information. So you can check out my previous thread here: https://www.felinediabetes.com/FDMB...-started-correctly-expert-help-needed.221204/ But long story short, my cat Duke is diabetic, he was on Glargine and we were really struggling with getting his numbers up high enough to even give him insulin. Because of our work schedules, he pretty much has to be given insulin in the morning. Anyway, the previous thread details how he had a couple of hypo episodes and I was advised to continue to give him less and less insulin. Which I did. But then it got to the point that legitimately I was emptying out the syringe and then giving him an injection of virtually nothing and only the tiny little drop that I could squeeze from an empty syringe. And guess what happened? I tested him after doing that and he dropped DANGEROUSLY low again, enough that he was likely going to go hypo so I had to use some SOS to get his numbers up. From that point on, Duke has pretty much been off insulin. There doesn't seem to be a dosage low enough to not cause his numbers to crash. He's been off insulin for months now. But the good news is, Duke's numbers aren't high. They're never in the 60s-70s but they range from 89-130 pretty much all the time. Even if he eats a bunch, I can't recall the last time he was even 150, but it's been months. He stays in that 89-130 range, usually in the low 100s. I'm told that "normal" cat glucose levels are 80-120, so for all intents and purposes changing his diet and regulating his feedings has more or less put him into remission, no? He only eats fancy feast pate and the occasional low carb boiled chicken. He acts like himself. He gets hungry (not quite ravenous but clearly hungry) but he only eats what he wants. In fact, lots of times he doesn't eat enough. He eats less than half a can at a feeding and then loses interest. We're constantly having to encourage him to eat more. SIDEBAR: When he was insulin he would NEVER eat, we were constantly doing things to make him eat, because we had to have his numbers up in order to give him a shot and then we were constantly shoving food in his face to make sure his numbers didn't crash. But when he was on insulin, he was sluggish, not at all like himself, and often seemed like he "felt bad" and he barely ate. NOW, he eats. He's got an appetite. But he's not eating as much as I'd like, or as much as he used to pre-diabetes. But he eats much better than he did on insulin. But he's still losing weight. He's gotten so boney. I can now feel his bones all over. He's energetic for the most part, he gets around better than he did when he was fat, but two years ago he was 14 pounds. By the time we found out he was diabetic, he was 10 pounds. He quickly went down to 9 pounds. We felt like 10 pounds would be a good weight for him and we were hoping to get him to about that. Then he dropped more, and we were like, let's keep him at 9, then let's keep him at 8... But now he's down to 7 POUNDS! I'm at my wits end. The vet has been very little help (we haven't taken him back in a while, but the vet just kept wanting to up his insulin dose earlier this year when we couldn't even get him up to 150) and I've researched this stuff until my brain wants to melt. Everything says weight loss = unregulated glucose levels, but most people are on here talking about giving their cats insulin to get the nadir down to 100 and Duke's preshot levels are around that number. How can he possibly need insulin? This past week as an example, we tested him 4 days, twice each day. Lowest reading was an 89, highest was 134. All others between those ranges. That may be slightly higher than a "normal" kitty, but is that a cat who is out of control with his diabetes?! I'm thinking that part of his problem may just be that he just doesn't eat enough. But dry food and higher carb food WILL cause his levels to shoot up. I can give him 900 cans of pate a day but it won't matter if he doesn't want to eat it. He just wants to eat whatever he deems enough and that's that. I know one of the last times I was here someone suggesting giving him higher carb food so that I then could give him insulin, but that seems very counter productive and again, once he's on insulin he pretty much stops eating regularly altogether. So I'm looking for thoughts, any thoughts, on what's going on and what I should do.
Any and all help is greatly appreciated. You guys have provided me a lot of information and comfort through this thus far and I appreciate it.
His numbers are normal range so yes, he's a diet controlled diabetic. (In other words, he's in remission just don't give him high carb anything unless he crashes which shouldn't happen if he's not on insulin.) The caveat -- I can't see a spreadsheet so this is my impression since we've had lots of people think their cat was in remission and once we saw the spreadsheet, the cat's numbers weren't remission numbers. (FYI - the range for remission numbers is a bit higher on an AlphaTrack meter.) The weight loss is worrisome. I'd suggest a vet visit and definitely get Duke tested for hyperthyroid. An overactive thyroid will rev up his metabolism and weight loss is one symptom. You could also transition to a higher calorie food. Take a look at Dr. Lisa's chart for a low carb, high calorie food. Wellness pates are one example. The fat content is higher.
I think it's really exciting that he doesn't need injections any more. I understand why you're worried about the weight loss. Sienne has good advice. Thyroid problems are really common in cats, and easy to treat. Are you able to take him to the vet now?
Has he had fleas ever? Tapeworms are passed to a cat by eating an infected flea and even if you do a fecal exam, they don’t always show up. Parasites in general, and tapeworms in particular, can really suck the weight off an ordinarily healthy cat. I’d suggest talking to the vet about a good, broad-spectrum dewormer. You say he just doesn’t eat well, maybe not enough. You might try other brands of low-carb food to see if that helps. But really, when a cat who has always eaten well starts trending into eating less or seeming picky, it’s probably time to go to the vet and have some blood work done. There are several possibilities, but I’d want to look closely at the kidney values. A thyroid panel is also a good idea, although hyperthyroid cats are usually voracious in appetite. It’s easy to default to assuming diabetes is causing the weight loss but if your BG numbers are correct, he sounds like he’s diet controlled. It never hurts to double check BG readings with a different meter just to make sure there isn’t something wonky going on with yours. Or you can’t test your own BG to see if the meter gives you a reasonable number. edited to add: How’s his urine output, volume wise?
Thank you for all your advice. I do plan on going in soon and updating his chart. That said, do you happen to know what the AlphaTrack remission ranges are? I don't recall hearing this before.
He's never had fleas or tapeworms or anything like that. He's an inside cat, so I can't imagine how he would be exposed to anything of that nature. If he continues to lose weight, I'm sure a vet trip is going to happen, I just hate to spend hundreds of dollars on lots of tests and panels and things for them to find nothing. When he got diagnosed with diabetes, they ran 5 billion tests and everything was good except for his glucose levels. But I guess that's just what we have to do. As for urine output, I don't really know. He could be peeing more, but he's always peed pretty frequently and he always ends up peeing on the side of the litter box so it always sounds like he's peeing a ton, but that's been that way his whole life. I don't know how else to check output. I do have some of the pee testing strips and am going to run one of those tests this weekend to see what comes up on that as well.
If you've been testing him lately, the last couple weeks worth of tests should still be recorded in the meter, so you could always get those back if you really wanted to update your spreadsheet. I echo the others, time for a vet visit and blood work. In addition to hyperthyroid testing, some GI issues can cause weight loss because they aren't processing their food right. The Texas A&M GI panel may help diagnose that. Or if everything else looks fine on blood work, you may need to get an ultrasound done. When cats get to a certain age, it's good to get periodic blood tests. Some things can be caught early that way, and treated.
