Hi everyone! It's been AGES since I've been on this forum, but I have a new issue with one of my cats.
Scout (12 year old neutered male), was recently diagnosed with diabetes. A little over 2 weeks ago, I noticed he was obsessing over the water dish (drinking for 5 minutes each time) to the point where his chest would be wet from water. He also seemed uninterested in food, and what little he did eat, he would vomit up (completely undigested). The next day, he had completely liquid diarrhea and was sitting in front of his water dish just staring into it (almost trancelike) So, a trip to the vet was in order. Just based on the symptoms, I was fearful of kidney failure, hyperthyroidism, or diabetes.
He has not lost/gained any weight since his last trip to the vet (his previous weight was 17.2 pounds, and this visit was 17.4). His blood glucose was at 301, potassium was 5.4 mmoL, T4 was 1.1 ug/dL (ruling out hyperthyroidsim), anion gap was 28 mmol/L, unine pH was 6.5, and urine gravity was 1.016. Also interesting is his monocytes were elevated at 1.17 K/uL. So the vet diagnosed diabetes. She gave him fluids, and prescribed lantis insulin, 1 unit twice a day as well as diabetic food (Royal Canin glucobalance). This was on September 1st, and he was started on insulin on September 2nd.
After getting fluids and starting on insulin, he seemed to feel a lot better, his appetite was back, and he wasn't drinking water excessively. But he still had diarrhea, so I took him back to the vet on September 3rd. They measured his BG and it was 230 about 1 hour after eating and having a dose of insulin. The vet prescribed Metronidazole for 7 days, which cleared up his diarrhea the next day, and everything seemed back to normal until yesterday.
Yesterday, he was not interested in breakfast at all (which is quite unusual for him) so I didn't give him his insulin. He was kind of gagging and licking his lips (like he was very nauseaous), and swallowing a lot, then he vomitted up clear/mucousy liquid (no bile or food). It wasn't "normal" vomitting for him - normally if he eats something that doesn't agree with him, he'll make this loud meow/howl noise, and then start retching, and I can actually see his abdomen contract - that did not happen here. A few minutes later, he had completely liquid diarrhea again. So, I went back to the vet, and they gave him more fluids and a shot of Cerenia for the vomitting. Shortly later, they offered him food, and he ate well, so he got a dose of insulin. At this point, my vet was suspecting pancreatitis, IBD, triad disease, or possibly intestinal cancer, so she referred me to a specialist for an abdominal imaging.
This morning, Scout was completely normal. He was not gagging or vomitting and his poop was normal. He was ready and waiting for his breakfast this morning, so he ate his usual amount and got a dose of insulin before heading to the specialist.
The specialist needed to wait a few hours after he digested his breakfast to do the ultrasound, but in the meantime plapated his abdomen and he didn't seem to be in pain, and he appeared adequately hydrated. So a few hours later, they did the abdominal radiographs and ultrasounds. The pancreas, liver, kidneys, adrenal glands, bladder, medial iliac lymph nodes all look normal. THe spleen was slightly enlarged, but did not appear abnormal. The only notable finding was what is described as "very mild, mucosal wall thickening identfied in the duodenum and at least one focal loop of the jejunum." She said this could be indicative of IBD or intestinal cancer. She ordered a GI panel and check of his fPL, which we won't get the results from until Monday/Tuesday next week. Pending the results of that, we may have to do an endoscopy to biopsy the small intestine.
She also gave me 4 Cerenia pills in the event he seems nauseous again.
Obviously, I'm terrified of intestinal cancer, but the prospect of IBD in a diabetic cat isn't exactly good news either since the typical treatment is steroids, which won't be feasible with a diabetic cat. But, I've read that IBD in diabetic cats is not all that uncommon. Does anyone have experience with this?
I'm also wondering if the vomiting and diarrhea are just symptoms of being on a new food, newly being on insulin, etc. Thoughts? Any suggestions/recommendations of any other tests that should be run?
He's still doing fine tonight, he ate dinner well, and pooped normally. He is still kind of swallowing a lot like he may still be a bit nauseous, but no vomitting so far...
Thanks in advance (and sorry for the crazy long post!).