Feline Diabetes
Mabel, 14, was diagnosed with diabetes in October, 2016. After a dangerous trial of the oral medication glipizide, prescribed by a veterinarian, we started her on the animal insulin Prozinc, commonly used with cats. Glipizide, I later read, should not be given to cats due to the potential for poisoning the cat's liver. By halting the glipizide within days and administering subcutaneous fluids, Mabel's liver toxicity reversed.
Overall the learning curve for treating Mabel's diabetes was very steep. Establishing the diagnosis and initiating treatment was also, for me, expensive. Whether other people decide to treat their diabetic cat depends on many variables, including but not exclusively the cat and the caregiver's age and health, the caregiver's ability, time, and resources to treat the cat, and the cat's endurance. In general, I would say it is a challenge but it is far from impossible. It does require commitment and dedication.
To know how much insulin Mabel needs I monitor her blood glucose levels myself with a meter made for human use. Home blood sugar monitoring is preferred by many diabetic cat caregivers to periodic readings at the vet clinic. One reason: your cat has to stay overnight at the vet's for vet techs to get readings over a period of time. The cat may be stressed staying at the vet's and the blood glucose readings may not even be entirely accurate. Your vet may take the cat's elevated stress into account when recommending insulin dosage. In addition though, the diagnostic and periodic assessments for insulin adjustment are an additional and not insignificant expense.
Back to the matter of insulin: during the first six months after Mabel's diagnosis we tried several different insulins, for at least one month each. The first, Prozinc, mentioned above, did not work well to stabilize Mabel. After a trial period on Prozinc, I switched to a longer-lasting insulin, Lantus, formulated for humans. I purchased one pen of Lantus, rather than a vial, and I extracted the small amounts of insulin from the pen using disposable syringes. I could not get Mabel stabilized on Lantus, but in addition she had also begun trying to avoid getting injected. Even though I found finer syringes (31 gauge), Mabel still recoiled from the Lantus shots. I found out why when I accidentally poked myself--the Lantus really stung. I changed insulins again, to Levemir. On Levemir Mabel stabilized and moreover, in April, 2017, she went into remission.
I'm pretty sure remission did not occur exclusively because of the suitability of the insulin. Most importantly, besides insulin, diet is critical! I learned a lot about feeding cats differently from a book that had been in my local public library all along: Your Cat: Simple New Secrets to a Longer Stronger Life by Elizabeth Hodgkins, DVM, published in 2008. I also took to reading Lisa Pierson, DVM, who urgently wants every cat carer to know about cat nutrition and health because she sees so much disease she attributes to poor nutrition. And, during the first month's of Mabel's diagnosis I turned to a very great resource online, the Feline Diabetes Message Board. I highly recommend it to anyone coping with feline diabetes.
A quick note about feeding a diabetic cat: in my experience it is not necessary to buy a prescription food. But it is necessary to provide a low carbohydrate diet. In fact, even if your cat does not have diabetes you can improve your cat's diet and perhaps in some part help prevent diabetes and other disease by transitioning to a higher protein lower carbohydrate diet. If you are caring for a diabetic cat now, a lower carb food is essential if you are hoping for remission.
You can read so much more about feline diabetes, caring for a diabetic cat, and caring for cats in general at Lisa Pierson's web site Cat Info. You can also find information about feline diabetes Cornell University Veterinary School. They have a special section on cats. And, Diabetic Cats in Need is a trustworthy non-profit organization serving cats and their humans living with feline diabetes. There is a lot of sharing, good support, and information at the Feline Diabetes Message Board. If you are coping with any aspect of feline diabetes, especially if you've just got the diagnosis, I recommend you get on the Board at FDMB.
Early in 2018, Mabel began showing signs of relapse to insulin dependency. By April, 2018, we had returned to a steady regime of a small amount of Levemir. Her dietary journey has been complicated by what I consider a lack of quality low carb dry kibble on the market. I have written about that at Feline Diabetes Message Board. I keep watching the cat food market for quality low carb food. And, of course, I hope Mabel will return to remission.
September 15, 2018, UPDATE on Mabel:
We returned to our veterinary clinic for a fairly complete blood panel and I understood the blood work did not signal underlying systemic problems more complex or profound than the diabetes already manifest. So I continue with the insulin Levemir dosed every 12 hours, preceded by blood sugar reading. Mabel does, however, have gingivitis, and very possibly also tooth resorption. Yesterday the technician administered an antibiotic shot that should fight any soft tissue bacterial infection for a couple of weeks and linger longer. Mabel also got a dose of subcutaneous fluid.
September 16, 2018. I write again after a night spent worrying over the controversial antibiotic shot Convenia.
Friday we journeyed to the neighboring village to the Vet Clinic. It can be stressful making the trip as my senior diabetic cat doesn't like leaving her comfort nest. She seems to know in advance in the way cats know things. She was hiding when it came time to go.
I had just finished transferring blood sugar reading numbers to the spreadsheet and emailed them to the Vet Clinic before we left. The main purpose of the visit had been to get blood work and an examination by a vet experienced with cats. I asked him to assess her teeth, her thyroid, the possibility of a UTI, because all these are not uncommon in older diabetic cats.
I was pleased her blood results were most of them within the normal range. I understood there are no obvious signs of major systemic issues now. The teeth are the thing though.
I never thought for a minute when I adopted her as a 6 month old I would be able to brush her teeth, but in retrospect, and had I understood then what I now do, I would have tried very hard to train her to let me. As a senior cat she may well now be suffering the consequences of gingivitis, periodontitis, tooth resorption--in sum, a painful mouth.
The Vet offered an injection of the 2-week antibiotic Convenia and I accepted. I did not go away and think about it overnight or research it, and if I had, I probably would have said no. I did ask clearly if the shot had side-effects and was clearly told no. And that just isn't true. I have now read both manufacturer side effect cautions and diabetic cat carers' accounts of side effects, shock, and even death of pets. And, I have read Lisa Pierson, DVM, on Convenia.
It is hard to weigh pros and cons when you don't really know much. Of course, I don't want Mabel to suffer. Cats are stoic creatures. I suspect something like tooth pain sometimes. I suspect something like aches and pains in her front legs sometimes. She isn't the classic surly or grumpy cat though. Not at all. She is proud, calm, dignified. She is aging gracefully. It is the great gift aging creatures can still give. Charity of soul.
On the other hand I sometimes wade into the shallows of resentment because I have foregone opportunities for the care of Mabel. Other carers of insulin dependent diabetic cats make this sacrifice, too. I know this from reading their stories at Feline Diabetes Message Forum.
Just a note more on the stereotype of the grumpy cat. If your cat is acting abnormal you may be observing a cat with any of many unresolved painful medical or dental conditions. From having closely observed the cats I've been raising, and from having to confront feline diabetes, I really believe in the inherent good nature of the domesticated feline. If you think your cat is exhibiting bad behavior intentionally, look to the cat's health and whether the cat is getting its needs met.
If you've ever watched a new healthy kitten play or observed the vigor of a vital adult cat or enjoyed the composed serene companionship of a senior cat, you might agree that the caricature grumpy cat is a human conceit fabricated in and by a deficit of understanding.
September 30, 2018
An update on Mabel. Her two weeks under the influence of Convenia are now over. I understand the antibiotic lingers for up to a couple of months but it isn't actively working. Maybe one could say it is in effect still in her system. I cannot with certainty say the ups and downs of the last two weeks were directly caused by the Convenia alone. Maybe it was a constellation of causes. There are always variables. Her blood sugar was more erratic. She had soft differently colored stool and at least one serious bout with diarrhea. She vomited more than she normally does. I had a helpful discussion with the veterinarian after the episode of diarrhea because I was worried it showed blood in the stool, too. He suggested she could have an ongoing though sporadic problem with irritable bowel, and that is certainly possible. We discussed probiotics in any case and I decided to reintroduce a probiotic into her wet food. Either that has helped or the diminished activity of antibiotic has helped, or both. She seems better all the way round.
I don't think I'll use Convenia again. Our vet said he would suggest a different antibiotic when she needs one. I measure her quality of life as best I can and taking my practical and also general ethical considerations into account, I do the best I can by her day to day.
Emmy
October 17, 2018
There's no need to think about a pet's end of life issues when your pet is young or in the prime of life, though accidents do happen. But once your pet develops disease one starts thinking about end of life. During the ups and downs since Mabel was diagnosed with diabetes two years ago I have sometimes anticipated her inevitable death. And six months ago a friend lost her dog, a favorite of mine, which caused me to experience pet bereavement. I watched as my friend assisted her dog through the final stages of her life, faced that difficult decision of timing, and let her dog go with mercy. It was after all this I decided that while it is fine to rely on instinct as long as you can, an assist by a quality of life scale could also be useful. It might lend some objectivity to an overwhelmingly emotional rite of passage. There are various versions of the pet quality of life scale online. Here is a link to the one provided at the Web site of the Association for Pet Loss and Bereavement: Quality of Life Scale
January 4, 2019
It seems this post on feline diabetes has had some readers lately so I'll give a brief update. Mabel is okay but not in remission again as I'd hoped. I read her blood glucose twice daily, with an occasional in between reading if she seems "off". She has transitioned to a diet of Dr. Elsey's Clean Protein kibble and low carb wet food, pates mostly. I check any unknown canned food on Lisa Pierson DVM web site at www.catinfo.org. Her wonderful food charts show carb, fat, and phosphates. The Dr. Elsey's chicken kibble is high protein and safely under 10% carb, their rep told me. The salmon kibble is higher in carb content; it contains chickpeas. She is pretty stable. She requires relatively low insulin dose at 1.5 units every 12 hours. We still use Levemir. And she has some real days, some good days, some lazy days, and that's not bad.
Emmy