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Dr. Gary
Dr. Gary, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 3844
Experience:  DVM, Emergency Veterinarian, BS (Physiology)
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I need help with a dehydrated diabetic cat. I have an older

Customer Question

I need help with a dehydrated diabetic cat.Hello, I have an older diabetic cat that has been on Glipizide for about 5 years (no insulin). Mostly she has been stable, but lately her fur has been oily with dandruf and she has lost about a pound (down from 9 to 8 pounds). Last week she started to vomit quite a bit and blood work indicated she was slightly dehydrated, but had a blood sugar level of 400. A few days later she stopped eating and drinking so we took her to the vet for Sub Q fluids. That did not help much and she continued to get worse. She didn't want to move and was not peeing or pooping. We then took her to the emergency vet and they gave her more Sub Q fluids and Celenium (sp) for nausea. Two days later we took her to another vet. They have kept her in the hospital on an IV drip since 12/29 @ 3:00. Today we were told that xrays indicated an enlarged liver and a small heart, and blood work did not show anything substantially wrong.Tomorrow when we talk to the vet, we would like a little better idea what to expect and other ideas about possible issues, so I am hoping you can help answer some of my questions.1) is it unusual for an older cat to have to remain on an IV drip for 40 plus hours? That seems excessive especially since we were told that after 24 hours she was still about 11% dehydrated and I think she was at 15% dehydrated when we dropped her off.2) Could dehydration cause the small heart and enlarged liver? Or would those issues be related to the diabetes?3) I suspect that the vet will encourage us to put the cat on insulin, but we are very hesitant to do so for a number of personal reasons. Given that, are you aware of any alternatives for stabilizing blood sugar in a cat? It seems the Glipizide is no longer doing a very good job.4) Because our cat is old (maybe 12 to 14) and rather weak and frail, we are wondering if insulin will even help much. If we put her on insulin do you think that will bring her back around enough that she will have a couple of years of decent living? Or will insulin just keep her around for a short time? Bot***** *****ne we don't want to make her deal with it if it really does not offer a better quality of life.Any advice you can provide will be greatly appreciated. Thanks
Submitted: 11 months ago.
Category: Cat Veterinary
Expert:  Dr. Barbara replied 11 months ago.

Hi, and welcome to JustAnswer. I'm Dr. Barbara, and I hope to help you out today with your kitty.

Customer: replied 11 months ago.
Thank you
Expert:  Dr. Barbara replied 11 months ago.

First a glucose of 400 shows that your kitty is not controlled at all, and that she has a need to be on insulin. Indeed, most cats need to be on insulin to control diabetes, and they usually benefit from a special high protein, high fat diet.

Expert:  Dr. Barbara replied 11 months ago.

The last blood work that was done didn't show she had an elevated glucose? Am I correct? Have they had her on insulin that you know of?

I realize that I haven't answered your specific questions, so while you're answering mine, I'll start addressing yours.

Customer: replied 11 months ago.
She had not normally run that high, usually in the 200's. We have her on Fancy Feast canned food and DM dry food.
Expert:  Dr. Barbara replied 11 months ago.

Actually, 200 is too high also, or let's say not ideal by any means. Do you feel you can't give her insulin?

Expert:  Dr. Barbara replied 11 months ago.

It's not unusual for an older cat to be on IV fluids for 40 hours, but what is unusual is that she would continue to be dehydrated even tho' her blood work didn't show and elevated glucose, kidney disease or liver disease. I do find it hard to believe that her blood work didn't show any of these things.

Customer: replied 11 months ago.
She has been diabetic for about 5 years and has never been on insulin, only on glipizide. While we know 200 is not ideal, she was pretty stable on it until recently. No we have not felt we could give her insulin.
Expert:  Dr. Barbara replied 11 months ago.

Dehydration definitely shows up as a small heart of X-ray. A large liver is highly likely, not from dehydration directly, but from anorexia in a cat for 2 or more days. They develop a disease called hepatic libidosis and the main treatment for this is eating or force feeding if necessary.

Expert:  Dr. Barbara replied 11 months ago.

Totally understand your reluctance to give her insulin. . .most people honestly feel that way at first. We could talk about that if you like, but your little girl has maybe more urgent problems right now.

Do you remember the values in her latest blood test for glucose, creatinine, BUN, phosphorous and liver enzymes? Do you know if a urinalysis was done? Did it show any ketones in her urine? Or was her blood ketone level measured?

Customer: replied 11 months ago.
Unfortunately they did not give us the number from the test yesterday, but they did say there were no ketones in her urine. Her glucose on 12/14 was at 400, and on 12/27 it was 350.
Customer: replied 11 months ago.
Is it typical to have to keep a cat on an IV drip for 2 days? That seems excessive?
Expert:  Dr. Barbara replied 11 months ago.

At a level of 200+ for her glucose, this would exceed a healthy kidneys ability to reabsorb the glucose from her urine, causing her to make excessive urine and be rather chronically dehydrated....or sure could do this.

Just received your last post. Wonderful that she did not have ketones in her urine, which means she is not ketotic and does not therefore have what we call complicated diabetes. But still,*****too high and means that her kidneys can't reabsorb enough fluid to sustain her and her cells are not getting the glucose in them that they need to survive healthfully.

Expert:  Dr. Barbara replied 11 months ago.

The length of time for IV fluid treatment depends upon a cats response to that plus other therapies. If she has remained dehydrated, then it is not too long for her. If her kidneys tested as normal in her blood work and look normal on her X-rays, and she doesn't show any fluid accumulation in her body cavities (chest and abdomen), then she is dehydrated because she is diabetic still as determined by her blood glucose.

I'll go up and continue to address your specific questions now while you write

Also, hepatic libidosis is likely here. How long since she has eaten?

I

Expert:  Dr. Barbara replied 11 months ago.

Oh, I just read your third question. The only other thing to do for a diabetic cat is to change her to a special diabetes diet. . .which they usually love. This can work to put some cats in remission for awhile, but usually they become diabetic again, just not as seriously diabetic.

She really does need insulin.

Expert:  Dr. Barbara replied 11 months ago.

Can't say that insulin will definitely help her, but with what you have shared so far, I think that it will. Insulin is really very easy to give, once you are instructed and have just a little experience. What has been your reluctance?

Expert:  Dr. Barbara replied 11 months ago.

So, also, how long since your kitty has eaten, and do you know if she had a special thyroid test called a free T4?

Customer: replied 11 months ago.
She has only eaten tiny amounts for the last 5 days. She is in the hospital now and they have been trying to feed her. She has eaten some, but we don't know how much. I don't recall if the previous blood test included t free T4, but none of the vets mentioned a thyroid issue.
Expert:  Dr. Barbara replied 11 months ago.

I only brought that up, because she is of the age where hyperthyroidism is quite common, and her weight loss and frailty would at least be greatly conributed by this. In the usual blood test a total T4 is run, and this can be erroneously suppressed by other diseases. . .like diabetes. A free T4 would give an accurate measure of the T4 level even in the face of disease.

Customer: replied 11 months ago.
I will definitely ask about the thyroid then as well.
Our cat is not a lap cat - she does not like to be held and we hate to force her down as she has a bad leg. She nearly lost her leg 3 years ago and it was re-attached with fish line. We are always concerned about causing her pain or further damage to the joint. We are concerned about first trying to test the blood with a meter and then trying to give the insulin when we can't get her to hold still or cooperate.
Expert:  Dr. Barbara replied 11 months ago.

It really is quite good that she has eaten even a little for you at home and for the doctors and veterinary technicians at the hospital. She may not have hepatic lipidosis then, especially if her liver enzymes weren't elevated. Do you remember if they were?

Expert:  Dr. Barbara replied 11 months ago.

Is she a calico kitty?

Customer: replied 11 months ago.
Again they did not give us the numbers this morning. They said her liver was a little high, but nothing they were terribly worried about. She is a tabby. :-)
Expert:  Dr. Barbara replied 11 months ago.

The easiest way I've found to give insulin is to put a cat in a top loading carrier or in a nest in a laundry basket. This keeps her from moving and exposes the back of neck and shoulder area.

Tabby. . .hmmmmm. Usually it's calicoes that are very independent and not lap kitties except on their limited terms. But of course, other colors can have these traits too.

Expert:  Dr. Barbara replied 11 months ago.

Any elevation in liver enzymes means something is going on. Hyperthyroidism will cause liver enzyme elevation as well as hepatic lipidosis.

Customer: replied 11 months ago.
We are also concerned about doing frequent blood tests to check her glucose level.
IF the thyroid is off, that should be easy to treat with a pill shouldn't it?
Expert:  Dr. Barbara replied 11 months ago.

Yes, should be very easy to treat hyperthyroidism.

She of course would need blood tests to regulate her on insulin, but your vet would start her on a rather low dose and then test her about 5-7 days later. What I usually do is at first run one test at the suspected nadir (when blood glucose would be the lowest). This is usually at about 8 hours after the morning dose. If this level is still too high, I increase the dose slightly and run the same test one week later. Only when her glucose is at the correct level for the nadir, do I run a (preferably 24 hour) glucose curve, checking the blood every 4 hours. This allows me to know the amount of insulin my patient needs and how often. Almost always, twice daily is needed, but sometimes once daily suffices.

Customer: replied 11 months ago.
Do you keep a cat while trying to determine the dosage or have the cat brought back to you frequently?
Expert:  Dr. Barbara replied 11 months ago.

You could bring her back every 4 hours, but most cats don't like being forced into a carrier and going in the car. Also, the stress of these trips can cause a cat's blood glucose to be elevated.

Customer: replied 11 months ago.
you would start the insulin then one week later test her over a 24 hour period? Can you clarify? Also could you answer my fourth question:
Because our cat is old (maybe 12 to 14) and rather weak and frail, we are wondering if insulin will even help much. If we put her on insulin do you think that will bring her back around enough that she will have a couple of years of decent living? Or will insulin just keep her around for a short time? Bot***** *****ne we don't want to make her deal with it if it really does not offer a better quality of life.
Thanks
Expert:  Dr. Barbara replied 11 months ago.

I would have her come in one week later only for one test run at her probable nadir time (usually about 8 hours after her morning insulin). This will probably still be high, but lower than when you started. With this info, I'd formulate her new insulin dose, and then repeat one week later. If she still was too high, I'd repeat this process until her nadir was at a good level (around 80). Only then would I suggest a glucose curve.

Customer: replied 11 months ago.
would we need to use a glucose meter at home? Isn't that a critical part?
Expert:  Dr. Barbara replied 11 months ago.

12-14 is not really extremely old for a cat, but she definitely has one disease that could cause her frailty. . .diabetes. She may also now be hyperthyroid too. Also, because her kidney function is good, I do really think that insulin is going to make a big difference for her!

Expert:  Dr. Barbara replied 11 months ago.

It is actually ideal to use a glucose meter at home. . .some people can do this and some can't.

Expert:  Dr. Barbara replied 11 months ago.

As I mentioned before, stress really increases the blood glucose level in cats so it can make regulating them a little more difficult, but not impossible. This is why I do recommend that the glucose curve be done in hospital, and preferable a 24 hour hospital. Cats do settle into their cages very well. . .they adopt their space and relax there.

Expert:  Dr. Barbara replied 11 months ago.

Home glucose checking can be done from ear veins which require very little to no restraint to use.

Customer: replied 11 months ago.
We are concerned about causing her any pain and doing the glucose testing frequently bothers us a lot. Isn't a cat's ear very sensitive to be tested twice a day? Would we run in to problems if we don't do home monitoring?
Expert:  Dr. Barbara replied 11 months ago.

She wouldn't have to be tested twice daily at all. Usually, the glucose meter is for times when she isn't acting right and you want to know where her glucose level is right then. To test her you would clean her ear with alcohol and nick an ear vein with the very small needle to get just enough blood to measure her glucose.

Expert:  Dr. Barbara replied 11 months ago.

Please excuse me for a few minutes. . .my dog seems to be in great need of a walk. Be back in a few minutes. . .hope you understand. :-).

Customer: replied 11 months ago.
LOL......TOTALLY. We also have an old rescue lab and one other kitty. I was just typing thanks for everything Dr B. anyway. It really helps for me to get other ideas and theories on what could be wrong with my girl, who walked into my yard one morning to eat a frozen waffle we tossed out for the seagulls. She has been here for ME since I returned from Iraq in 2004. She is the BEST therapist I have ever had. I know I am gonna lose her soon. But I seriously think I have seen her use at least 3 of her 9 lives to stay here with me a bit longer... :o) Take care and thanks again Doc.
Expert:  Dr. Barbara replied 11 months ago.

You're welcome, and thanks so much for your service! Emma just needed to pee. . .but it was very urgent!

I have worked with myriads of people new to insulin, so please contact me again as you are initiating insulin treatment if you need.

Also, if you still have questions or concerns right now, don't hesitate to ask or state.

Happy New Year to you and your family!

Dr. Barbara