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Dr. Taus
Dr. Taus, Veterinarian
Category: Veterinary
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Experience:  Veterinarian with experience in equine and small animal medicine.
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I have an adopted cat (were guessing that she is around 9

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I have an adopted cat (we're guessing that she is around 9 years old) who is having some balance problems.

About 2 1/2 weeks ago I woke up early in the morning to the sound of her throwing up. When I got out of bed to clean it up, she tried to walk toward me but she looked like she was drunk. Wobbly, couldn't take more than one step at a time without falling over, head bobbing, etc. I rushed her to the emergency vet clinic but by the time I got her there (it's aXXXXX she wasn't wobbly anymore and was acting scared but normal.

The vet ran a complete blood count and EKG. The only things that showed abnormal were elevated glucose (242) and tachycardia with slight irregularity. The vet told me that he suspected early heart disease.

When I got home and called my regular vet (they were open by then) they said to monitor her for a few days and bring her in for a check up. She had no further episodes and was acting fine, so when I brought her in they checked her blood and her glucose was low (42) and though her heart was beating fast it wasn't irregular. He thought that the act of vomitting irritated her vagal nerve and that's what made her lightheaded/dizzy.

It's been almost two weeks since then and she has had no more episodes but she is more unsteady. She is slipping and falling more often and seems very hesitant to jump down from anything.

I want her to have a good quality of life and I love her very much but I don't know if I should be worried or not.

Your thoughts?

Hi there,

I'm sorry to hear that Rhapsody isn't feeling well. 42 is really a very low number for glucose in an adult cat. Even in a cat that isn't eating, it shouldn't be that low. It is worrisome that either she is producing too much insulin or something is using up her blood sugar. Lightheadedness and loss of balance can be signs of very low blood sugar.
While blood glucose can be artificially reduced if the blood is allowed to sit for several hours before running it, it sounds as if your cat's symptoms fit with her blood sugar being that low.

I would be worried about an insulinoma, a condition where her pancreas produces too much insulin. These cats often don't produce too much insulin all the time-- it can come in bursts, causing signs like you saw. Your vet could do imaging and further testing to rule this out (although they can be tough to find).

I also think a full neurologic workup is warranted to make sure she doesn't have a problem in her cerebellum, the part of the brain that helps coordinate movement. This is unusual, but a possibility. This would involve a physical exam by your vet looking specifically at her neurologic system and potentially imaging if it is warranted by the exam.

Heart disease is certainly a possibility, but early heart disease usually doesn't cause syncope that could look like what you describe. That's usually a later development. I would consider checking her blood pressure, if it hasn't already been done, but I wouldn't put much faith in the heart rate of a stressed-out cat.

I hope this is helpful. If so, please rate me positively, and don't hesitate to let me know what questions you have.
Customer: replied 3 years ago.
Thank you for your reply!

How is insulinoma different from and diagnosed differently from diabetes?

Also, would either of these conditions cause her pain? Are there specific signs I should look for that would tell me if she is hurting?
Insulinoma is the opposite of diabetes. In diabetes, there is not enough insulin, so blood sugar goes too high. In insulinoma, cells produce insulin in too high of quantities and when it isn't needed, causing blood sugar to fall too low. Insulinoma can sometimes be seen as a mass on abdominal imaging, but is sometimes too tiny to see. It can also be diagnosed by measuring her insulin and showing it is high while she is having symptoms. If she is having symptoms (beyond what we can attribute to being nervous about attempting a jump she might have failed before) and giving her food or karo syrup during that time makes her better, that is also supportive information.

None of these conditions are expected to be specifically painful, but they may make her nervous, fearful of motions that have not worked for her lately, or lethargic and weak. If it is heart disease or insulinoma, it is also possible for disease to progress to become life threatening, so it is important to track down what this is if possible to treat it. I do not expect her to benefit from pain medication at this point though.
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