Expert: Jessica - 11/8/2009

Question
QUESTION: Hi there,
I have a 16 year old male cat who has been diabetic going on 5 years. Up until last week, he's been terrific. For at least a few days, he was probably getting too much insulin (our glucometer was in getting fixed so we couldn't test him). I had noticed he was lethargic and just not himself. Last Tuesday, we took him to the vet and they suspected kidney disease so ran some blood tests. The on Friday they asked for a urine test to confirm some of the findings from the blood test. On Friday, he went from bad to worst. He almost stopped eating completely so we didn't give him his insulin. On Saturday, the vet gave me an appetite stimulant and it worked enough to give him his insulin on Sunday which resulted in him improving. All week long, he was somewhat okay - eating a bit better and getting some strength back. On Friday, he had another blood test and urine test and both came back completely normal - no kidney disease. But he's still not eating very well. But before this happened, the vet recommended changing his food (he was on Purina for diabetics and now he will only eat Hills p/d which is for kittens). The vet doesn't think she needs to see him for another 3 months, but he's clearly off - is this just old age and the effects of long-term diabetes? He will eat some things, like ham, tuna and carbohydrate treats (bad for diabetics. Should I worry more about getting anything into him instead of trying to get him to eat well?
Thanks!
Nicole

ANSWER: Hi Nicole.  I've never seen diabetes itself cause a decrease in appetite, only an increase when their diabetes is uncontrolled.  I assume the vet checked all of his blood cell counts, as well?  If these were all normal, then it would seem he doesn't have an infection that could explain his symptoms.  

One disease that may be seen more frequently in diabetic cats is pancreatitis, and the most common symptom of this is anorexia.  There are a couple of pancreatic values that are taken into consideration on standard blood work ups.  However, they aren't the greatest indicator of pancreatic disease.  Ultrasounds can be helpful, but the most reliable non-invasive test is a blood test called a PLI, or a new, faster version called the SPEC-FPL.  Your vet may have reasons why pancreatitis is not suspected, but you could certainly ask about this condition and having a test done to rule it out.  

When a cat just isn't doing right and I know it, yet blood tests come back normal, I tend to have an abdominal x-ray or ultrasound done.  These can determine whether the heart is of an abnormal size, if there is any fluid where it should not be, or if there are growths anywhere.  Some people are surprised to find their cat's symptoms are due to swallowed string or plastic.  Other times, cancer can be the cause, and imaging can help diagnose these.

As for his eating, the thing of greatest importance with a diabetic cat is, indeed, to get him to eat something - anything.  Better for a diabetic to be on junkfood than no food.  I prefer chicken over tuna and ham only because there's no worry of too much sodium (as with ham) or vitamin E depletion (as with tuna), but you can feed ham or tuna for a short duration.  Lean ground beef is fine for a little while, too.  You could also experiment with some grain-free foods on the market, which tend to be fashioned a little more like Purina's DM - high protein, low carb, which is great for diabetics.  I feed my cats Taste of the Wild (www.tasteofthewildpetfood.com).  It's good for their bodies, they go for the taste, and it's pretty easy on the pockets (especially compared to Hill's and Purina prescription foods).

However, if he's not back on some complete cat food within a couple of weeks, you should talk to your vet about an appropriate food to force feed until he gets back on his feet.  Meat is a good source of protein but doesn't contain enough taurine and essential vitamins and minerals to keep him healthy.

I hope he's feeling much better soon!

Jessica



---------- FOLLOW-UP ----------

QUESTION: Hi Jessica,

Thanks for your response. I called the vet and they had done some tests that would suggest that it wasn't pancreatitis. While his appetite has sort of returned (it's hit and miss), he seems to be breathing differently as well. I'm not sure if this is new or something I haven't noticed before. It seems like he's taking lots of deep breaths, maybe breathing a little harder than usual. His behavior is up and down - sometimes totally normal, sometimes very lethargic. Does this sound like heart disease - he doesn't have any other symptoms and he's not panting.  Thanks!

Nicole

Answer
Deep abdominal breathing, when the cat uses his diaphragm to draw in breaths, can be a sign of heart disease.  It is certainly one of the top things on the list to suspect when patients come in with deep abdominal breathing.  But problems like asthma, which is far less grave, also will cause this.  I think with this new realization that an abdominal x-ray or ultrasound would really be a step in the right direction.  Unfortunately, if he has asthma, you won't be able to control it in the traditional way - with oral steroids, because he's diabetic.  But inhaled steroids might be an option, using a specialized inhaler for cats.  There are also anti-rejection drugs that can be helpful.