Pets with Diabetes: Coho's Story

Coho is a spayed 10-1/2 year old female tortoiseshell DSH who adopted us when she was about 5 weeks old. She is a big cat physically, weighing in at about 13 pounds. An ideal weight for her is probably about 12.5 pounds.

She has had diabetes for about 4 years that up to now has been [fairly?] well-controlled by 2.8 unit twice daily shots of (40 IU) caninsulin. Early on in her diabetes, she had 2 hypoglycemic episodes that were treated successfully at home by providing sugar, and then missing a shot or two, until she was back to 'normal' as judged by thirst, urination frequency and diastix for urine glucose.

Unfortunately, Coho has also had an almost lifelong (about 9 years) history of skin allergies that have been treated with long-acting cortisone injections. These injections have been required to keep her allergies under control about every 4 weeks to 2 months. Whenever the cortisone shots were given, her diabetes would swing wildly out of control, but we carried on giving her the same daily insulin dose recommended by the veterinarian until she was back in balance ( as seen by her urination frequency/amount, urine glucose, and thirst). Occasionally, we would adjust the dose minimally to account for less food intake, etc.

Her specific allergy symptoms showed themselves first as swellings around the mouth, but have progressed to more distressing skin problems (itching, licking, and pulling out fur on her legs and back). The cortisone injections seemed to control the problem for a time and gave her some relief from the discomfort of her allergies. When she developed diabetes about 4 years ago, my husband and I wondered whether the cortisone may have been responsible. Although we were concerned about the cortisone/diabetic reaction, we were assured that the cortisone treatment was the most effective for allergy-suffering cats.

At the end of this March, we took Coho in to have the vet look at her mouth, which had again developed some swelling. She had also been pulling out fur and licking spots on her back and legs. Our vet advised that Coho should have her teeth cleaned [to reduce opportunities for bacteria] and a closer examination of the swelling area. She was anesthetized, her teeth were cleaned, and we came to pick her up later that afternoon. Right away, it seemed that something was wrong. She appeared extremely lethargic...maybe drugged we thought... and was very weak. We took her home and watched her closely, but instead of reviving normally [she had her teeth cleaned previously with no ill effect other than the normal effects of anesthetics], she appeared to be getting weaker. We phoned the vet, and he advised to hold off on all medications including insulin and to observe her status and report back [she had been sent home with ear drops and antibiotics]. By the next day she was very ill and weak, and was unable to walk without falling over.

Since she was shaking her head and falling over continually, inner ear infection was suspected. We started antibiotics, and had to hand feed her for about three weeks before she was able to get up and around a little on her own. Unfortunately, she seemed to have lost her appetite totally, and her mouth was still swollen. Our vet administered another cortisone injection, and we continued to hand feed, and coax her to eat on her own with limited success for another three weeks. Our vet was puzzled by her situation, and couldn't understand why she wouldn't eat. Although we had been hand feeding her a special vet diet for sick cats, Coho's weight dropped to 10-3/4 pounds and we were all very concerned.

During this whole time, we had administered insulin only occasionally and in reduced doses, and although there was no BG or urine monitoring done, fortunately we avoided a hypoglycemic episode. We were very concerned however, because since her food intake was so erratic, it was hard to 'judge' how much to give, as we had done [more or less successfully] in the past. The vet was also still not sure what had triggered the infection to begin with, or even where it was.

At this point, Coho was referred to a vet specialist [internal medicine] to see why she wasn't eating and was still losing weight. The specialist ran a whole series of tests, and after determining that the infection [whatever it was] was gone, and eliminating other potential problems, prescribed oxacepam twice daily to stimulate her appetite.

Coho started eating on her own again thankfully, due to this medicine, but we were still having trouble getting urine glucose measurements. We got a few, but they were too spotty, and unreliable to make safe determinations for insulin requirements. The few urine glucose measurements that I had were for 26 mmol/l [468 mg/dl].

Since she was now eating well as a result of the medication, Coho had to be started back on regular insulin, and we began with her regular dose of 2.8 units twice per day. She carried on with this regimen for about 7 days, when we were told to reduce the amount of oxacepam gradually over the next while to see if she would continue eating on her own. Her eating tapered off, so we cut the insulin dose in half. When we increased the oxacepam again, her eating again improved, and her insulin dose was correspondingly again increased to 2.8 units for another 8 days. On the ninth day she crashed.

Due to the crash, we were told to hold off on her evening shot of insulin, and to restart her the next morning at 1.6 units. After this one reduced dose, Coho seemed on the verge of another hypoglycemic incident, and I fed her and watched her closely for the rest of the day. When I tested her urine that evening for glucose, her urine test strip measured no glucose in her urine. We discontinued insulin pending further urine results, and she was still negative for urine glucose the following night. Two days later, when she [finally] peed again, her urine glucose now read 10.3 at 4pm in the afternoon. The next morning, her urine glucose came in at between 7 and 14 mmol/L. Coho had received no insulin for 4 days.

She was scheduled for a return visit with the specialist the next day. There her BG was 11.4 mmol/L, which considering her stress level, was not that high. Further testing had confirmed that Coho had no serious health issues other than her ongoing allergies and diabetes. Her kidneys and other organs were functioning well. After four weeks, Coho had regained almost all her lost weight (she was back up to 12.6 pounds), and the vet now wanted her to remain at this weight as this seemed more ideal for her size. The vet advised to begin administering 1 unit of insulin twice daily starting that evening. Coho was also prescribed oral prednisone and periactin [to control her allergies], and was taken off oxazepam at the same time.

Since we had been trying not too successully to accurately measure Coho's urine glucose, the specialist suggested that we change her cat litter to non-absorbent aquarium gravel to make the whole process easier. This worked very well and helped us over the next while to obtain several good urine glucose measurements.

That evening and the next morning, Coho received her 1 unit, but began to look and act hypoglycemic about 9:30am. Because I was unfamiliar with the effects of the other drugs that had just been started [prednisone and periactin], I wasn't sure if she was crashing, and delayed administering sugar. By about 1130am however, I was sure that Coho was crashing seriously , and after administering honey and seeing her revive, I took her in to her regular vet for BG testing. Her BG was 6.4 at 1pm [after having already received a half teaspoon of honey and reviving], and as she was still shaky, I was told to give her more honey or syrup if needed as the afternoon went on. In fact, I had to give her two more doses of honey [altogether about 4.5 ccs] over the afternoon, before she finally came more back to her normal self.

She remained off insulin all week, and her urine glucose measurements were 111+ every evening, and 56+ every morning. There were no ketones in her urine fortunately, and although she was off insulin and her urine glucose seemed very high [I was told this was the Somogyi effect], her allergies seemed to be better controlled with the oral prednisone and periactin combo. Seven days after this crash, I was again instructed to start up insulin, but this time at 1 unit per day in the AM. Once again, I gave Coho the insulin as instructed and watched her closely, and once again, she began acting strangely, but this time quite oddly. She repeatedly tried to run into inaccessible corners [under furniture, etc] and growled loudly whenever I approached. I moved furniture, offered food and coaxed her to eat several times over the next few hours, and after about 4 hours, she appeared to be coming back to normal behavior once again. I called the vet and was once again been advised to hold off giving insulin until next week. That was yesterday; today is Sunday, and the specialist will be back in on Tuesday.

Coho's diabetes most likely was a long-term reaction to the cortisone. The specialist has advised that Coho may not actually even be diabetic, if her allergies can be controlled without cortisone shots. Since Coho now seems to be so sensitive to insulin, she may prove very hard to regulate, and I am seriously considering the purchase of a blood glucose monitor so that I can know with some level of assurance what Coho's insulin level is before I give her any more insulin. I'll be talking to the specialist about this early this week.

I guess that we were very lucky over the past four years that she was as stable as she was over the past four years of diabetes treatment in spite of her cortisone injections. In just a short while, we have learned a lot about diabetes, and will be much more closely monitoring her situation in future. In spite of the recent crashes, we are hopeful that better allergy control will eventually alleviate her allergies and maybe even lessen her diabetes. Wish us luck with her control!

-- Contributed by Ellen Warner

	Coho's Story