Angel and Diabetes

It’s been a busy… wow, three months! While doing well over the summer and off all anti-depressant meds, I accidentally founded the site Cheezland, which has been taking up quite a bit of my time since. Trick went to the vet for what I thought was a gum abrasion, which turned out to be no less than three dental neck lesions (cavities) in 3 quarters of his mouth, two of which had broken off – and while I was feeling terrible for not noticing that, we discovered he had a very severe bladder infection he’d probably had for some time, with no sign of it (no litter box use change at all), and that took two courses of antibiotics to treat, along with food for the crystals that had formed. Cory was plucking his own fur out and creating bald patches, which appears to be an allergy of some kind – and the last time he was on steroids, the usual allergy treatment for cats, he gained a huge amount of weight rapidly. Nonetheless, he’s been on low-dose steroids for some time, and while his weight has gone up a bit, that combined with an antihistamine and a topical goo applied similarly to Revolution (the omega-fatty-acids food supplement gives him diarrhea *sigh*) he’s not itching currently. If, when his steroids run out around the end of November, he resumes itching and plucking, then we’re going to have to conclude it’s a food allergy rather than an environmental one, and he’s so fussy about food with such a sensitive tummy that it’ll be a nightmare.

While we were trying to get the pet insurance company to usefully help out (dental isn’t covered, prescription food isn’t covered, I was starting to wonder what IS covered), Angel started urinating more and drinking more. She’s had issues with food for as long as she’s lived with us, she gets crazy-anxious if there’s no food available and then gorges herself as soon as it’s back; even though we’re careful to avoid that, and found a way to keep her from gorging (forage balls or food balls, which I keep meaning to do a post on), she’s still a big girl, just a shade over 8 kg (17.6 pounds), some of which is devastatingly strong muscle and some of which is floof and some of which is fat. Suddenly, though, her borderline desperation for their once-a-day wet food went up dramatically.

Nine-year-old overweight cat. Polyurea (increased urination), polydipsia (increased thirst), and increased appetite. That only adds up to one thing.

Off to the vet, last Wednesday (thanks to an amazing ofice manager who’s willing to let us pay things off as quickly as we can but doesn’t insist we have it all up front!). Blood work to confirm it, but I don’t think anyone really had any doubts. We needed a urine sample, too. Angel’s appointment was at 2:30 pm; at 8pm when they closed, I went to get her, and she’d been refusing to cooperate the whole time. (Cystocentesis, getting a sample directly from her bladder via a very fine needle, wasn’t an option because the vet couldn’t find her bladder by touch.) Got her home, she had a long drink of filtered ice water (she’s spoiled, sure) and then emptied her bladder. :roll: No use because we needed a fresh sample to get to the vet immediately.

The next day, after three hours of Angel and I alone in one bedroom, me reading around encouraging her to have more water and wet food, her refusing to pee in the clean litter box that had juts a bit of non-absorbing pellets in it, I was getting a bit worried. Tried giving her a regular box to dig in (she really likes to dig!) and then, as soon as she started, moving her to the empty box to continue – nope, she immediately stopped. Checked with the vet office what the bare minimum sample size was, and was rather surprised to find that 2cc, 2 ml, would do it, but more would be better. 2cc is practically nothing! Thanks to nicewitch, an friend who’s been through this, I tried a long-handled serving spoon with a narrow deep bowl, and gave her back the regular litter box, and, well, slid the spoon into place while she was using it. I got easily 20cc that way. Yay!

Normal kitty blood glucose is about 8. Angel’s was a shade over 24. Not as bad as it sounds, my Nermal’s was over 30 and we got it under control. Slightly elevated liver enzymes, which can apparently be secondary to diabetes. Her pancreas levels were rather dramatically elevated, far more than they were a year and a half ago when she was diagnosed with and treated for symptoms of pancreatitis (“itis” always means “inflammation of”), even though she shows no symptoms (abdominal sensitivity and pain). Otherwise, all good, including her urine. Yay!

The vet believes we have a very good chance at getting it into remission. There’s a specific human insulin, glargine, also found under the trade name Lantus, that she’s had excellent results with. Seanya and I each did a practice injection with IV fluids instead of insulin, and Angel was a very good girl, never even flinched (well, they’re pretty tiny needles, half-cc U100’s). The vet also showed us how to get a blood sample from the vessels in her ears, which we won’t have to do often, which is good because Angel cared much less for that. We’ll have our own kitty-calicobrayted blood glucometer soon, the vet is ordering one for us.

The vet’s office cheerfully provided a box of syringes. Insulin, surprisingly enough, doesn’t require a prescription! The vet suggested a couple of places to try that were inexpensive; Seanya did some calling around, found out that most pharmacies didn’t know the generic name but recognized the trade name once she researched it, and lo and behold, our own pharmacy has it at a price less than a dollar more than the cheapest suggestion from the vet – which would have cost us $2.50 each way on the bus.

Diet is going to be a problem. She NEEDS to be on a low-carb diet of high, and high-quality, protein. I’ve been through that before, when my Nermal was diagnosed with chronic renal failure. Angel gets serious diarrhea from corn and wheat anyway, but also, unfortunately, from (most or all, not sure) fish. They free-feed a high-quality chicken-and-brown-rice kibble, and get two cans of Fancy Feast split between them once a day, normally – the ONLY wet food Cory will eat is Fancy Feast Elegant Medleys Chicken Florentine, and not even much of that, and previous attempts to convince the lot of them that they really would prefer high-quality grain-free wet food have been successful only for short spurts involving significant wasted food. So far, she’s declined the brand the vet suggested, and ate a bit each of two other kinds. Next on the list: see if we can freeze some in ice cube trays so we don’t end up tossing out half a can of expensive food every day. The possibility exists that she’ll refuse to eat the high-quality stuff; mixing it with Fancy Feast pate might do it, or we might be forced just to give her all FF pate. Trying to coax a cat into a change of diet, especially when it’s very important she doesn’t miss meals (PLEASE NOTE: missing a meal isn’t critical for most cats, but especially for an overweight cat, not eating for 24 hours or more can lead to lethal liver complications!!!) is always a major headache. We’ll do the best we can, I suppose. I’ve had to stand my ground with my vet before (same vet office, different vet) over food with Nermal, since there are, or were?, two schools of thought on renal care diets: low-protein prescription, or high-quality protein, the intent of both to produce less waste for the kidneys to process. (I’m firmly on the side of the latter.)

We could have given Angel her first insulin injection last night, but the vet was closed, and we decided, just for the million-to-one chance of a bad reaction, to wait until this morning. I gave her a can of Fancy Feast beef pate, to make sure she had a full tummy, and while she was eating, gave her the shot on her side around level with the base of her ribcage. She looked up at me once to try to figure out what I was doing, while I was trying to find skin in all that fur! but otherwise ignored the whole thing. That was an hour ago, and it’s all good, no bad reactions. So, I guess we’re back to our lives being controlled and regulated by kitty health-care schedule again! Nermal was diabetic, on oral hypoglycemics (pills) twice a day to manage it for quite a long time, then for something like eleven weeks I fought to deal with his renal failure (and failed). Loki had asthma and was on puffers twice a day. Can I get a degree for personal experience in feline home health care? :-)

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