I took care of quite a few when I was a pet sitter. It’s not that hard usually. Most of the cats came out to eat and didn’t seem to be bothered by the needle.
One would hide from me, another one would make me chase him - who knew an old arthritic cat could run so fast? You’d think he was at death’s door until he saw me coming with the needle. Once I caught them they would just sit still for the shot.
Giving a cat a shot is for sure a lot easier than pilling them.
Most of the cats lived to be in their late teens, one even made it to 20, so it is certainly not a death sentence.
What insulin is he getting, and what kind of food? Canned is best, and pate style without any wheat gluten is best. (In many cases, the formed “filets” and “bits” and “morsels” are not nearly all meat and are instead made from a little meat and wheat gluten). Without the availability of Rx food, going all canned and lowest carbohydrates is your next best bet. Don’t be fooled by “grain free”, as those simply contain crap like sweet potatoes that aren’t part of a feline diet, either.
And I don’t know if this will help, but here’s a Cornell article about feline eosinophilic granuloma complex. It all depends on your kitty, but if he gets the lesions and he leaves them alone, you can skip the steroid treatment and see if it resolves on its own. The lesion may be ugly, but if he’s not bothered by it then you can let it run its course. If you can find a limited ingredient canned food with a single source of protein, that may also help in case the granulomas are allergy related. If you’ve been feeding a certain protein lately without a flare-up, then go with that one. Hopefully it’s a common one like chicken or beef. It’s possible his flare-ups have happened when he gets a protein he’s not used to, like venison, rabbit or shellfish.
Keeping an anti-parasitic topical medication on your guy may also help, if he’s getting an occasional flea bite, that could be causing his granulomas, too. Be careful with what you use on him, though, as ones that work on dogs can kill a cat (Pyrethrin and pyrethroid based medications can cause seizures that can’t be stopped). I’m mentioning this because of your location and what’s available might not be labeled well - I’d stick with what your veterinarian sells.
I do diabetic cat education and training as an ER vet tech and worker at a feline rescue. Let me know either here for others to see, or in a PM, if there’s anything else you want to know. That Cornell site also has diabetic cat information, including 30 minutes worth of videos. Hoping you can access them from your location.
I certainly can’t give you any better advice than SeaDragonTattoo. I will tell you that my beloved Fred did very well on insulin and canned food for many years. This isn’t horrible, the needles are so fine that they don’t seem to notice the shots. Your lucky kitty (the horrible things that happened to him were horrible, but he’s really lucky to have ended up with you) will probably be OK.
My warning is that you need to be careful when you are filling the syringe for his morning dose. Its easy to fumble one of those small things and give yourself a shot in the finger if you haven’t had your coffee first. The dosage is so small that your body won’t notice it, but the meds are not cheap and you don’t want to waste it that way.
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What insulin is he getting, and what kind of food?
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Here’s what the insulin supply says:
Lantus Solostar
Insulin Glargine
100 IU/ml
On food - he’s getting whatever we can buy, which at the moment is Whiskas pouches made in Thailand and an Australian canned catfood (labeled with ??Chinese or Japanese characters, so clearly intended for export) called Supercat. We used to feed dry food - Hill’s Science Diet - but I’ve decided to switch entirely to soft food for both cats (we also have a 14-year-old tabby girl, with no known health problems but definitely aging; she has started to seem old to me even though she’s energetic and seems happy).
Sometimes I can get Friskie’s canned catfood for kittens and that is a hit. Is it okay to feed adult cats kitten food? Neither one has a weight problem; in fact both are on the thin side.
I’d like to make catfood for at least some of their meals, but the info I’ve seen on the internet has turned me off - it seems like you have to use raw meat (not gonna happen as there is no way I trust what we can get to be free of bacterial contamination) and make a huge production out of it. OTH, if I could make a paste of freshly cooked chicken/fish with a bit of egg and brewer’s yeast, or something like that, I would be happy to serve up homemade catfood at least part of the time. (I used to feed my cats a diet of that with some rice blended in decades ago and they were fine, but that was two young healthy cats.)
Anyway, if anyone has suggestions for PRACTICAL recipes for homemade catfood, I’m all ears.
Thank you for the link - I will read up!
Unfortunately he is VERY bothered by the lesions. I’ve been through the progression with him several times: at first he becomes picky but will reluctantly eat soft food, then he needs to be hand-fed tiny morsels of finely shredded meat or fish but can be coaxed into eating enough, then he gets to the point where he reluctantly tries a mouthful or two when he’s starving, only to screech in agony as he works his jaw in obvious pain, and runs away crying to hide - it’s an AWFUL thing to see. As the granuloma flares up, his mouth bleeds so badly that he gets a little beard of dried blood on his chin. There’s no way we could let the flare-ups run their course; he’d die of starvation first, with tremendous pain every time he tried to eat. So, the steroid shots have been necessary (though the vet says she’s going to try oral cortisone next time, so we can administer it at home instead of having to drag him to the vet).
The food allergy question is an interesting one. He first had trouble when the bulk of his diet was Hill’s dry catfood. But he’s eaten progressively less of that, and more canned stuff, as he’s had more trouble.
The vet thinks he may be FIV positive, which is compromising his immune system. Apparently it is extremely common among Indonesian street cats. The vaccine is not available here in Indonesia. It’s an interesting theory - we lost a cat about 18 months ago to some kind of growth in his throat, and I wonder if he was susceptible to problems because of being FIV positive. Meanwhile, the 14-year-old tabby, who is insanely jealous of other cats, is smugly watching the other cats around her suffer. Could she be a carrier - able to fight it off herself, but infecting others? She definitely tangled with the others enough to bite them once or twice, and I gather this is the typical mode of transmission.
There are tests available for FIV here, so if there is anything I should do differently based on finding out that either of the cats do or do not test positive, I’ll have them both tested. On the hand, if it will have no impact on cat care, there is probably no point, at least until such time as we contemplate bringing another cat into the household.
I can answer more in depth later, but as far as feeding homemade food, as long as offal is included, you’re good. I don’t recommend raw diet in case of FIV, but following the raw ingredients list is fine. Cook the meat/offal first, then add supplements after cooling. Cats go blind without taurine, which is not available in muscle meat.
If you go with the assumption that he’s FIV+, that would probably be fine without testing. Clinically it’s helpful to know for sure, as if he is FIV+, it could explain the granulomas. It’s not unusual for FIV+ cats to have ongoing dental issues, like those lesions, and stomatitis, and generally poor dental health that results in the need for dental cleanings and extractions more often. Many FIV+ cats that live in homes and get regular veterinary care end up without teeth before they’re double digits in age.
One other thing that vets I know would test for, with his oral lesions being so bad, is Bartonella. If he’s ever had fleas, he could be carrying Bartonella. It’s an easy blood blot test, but as far as I know there’s just one lab in the US that tests for it - so I’m not sure whether it’s an available test for you in Indonesia. The treatment for Bartonella is a 21 day course of Azithromycin. While a trial treatment could certainly be done without testing, there’s a re-check titer that needs to be done a few months later to make sure treatment was effective. If it wasn’t, the cat will remain symptomatic and needs another course of antibiotic treatment, either a longer course of Azithromycin, or a different course for 21 days or more of Rifampin. Without testing available, talk to your vet about it as s/he may decide trying the courses could help. Here’s the National Veterinary Laboratory website with info: http://www.natvetlab.com/
The glargine insulin is a great one for cats. It’s long acting and that’s how you’re able to give doses just once a day. The trick with glargine - not to scare you - is that an overdose then doesn’t last for a few hours like with normal insulin (which acts for 8-12 hours) but for 24 hours or more. Get the smallest insulin syringes you can find - I use the ones that are 30 units, or 1/3 of a CC, as the lines are a little farther apart and measuring one unit is a tiny bit easier. Hopefully you can find them. The usual sequence is to feed, then give the insulin - because you don’t want to give insulin and then have the cat not want to eat for whatever reason. With glargine, feeding smaller portions more frequently as your vet instructed is exactly right.
If you think trying to test his blood glucose might be something you would want to try, I’ll go into that. It’s an ear prick and he needs to hold still for a minute, so you’re the best judge of whether he’s a candidate for home testing. I had a very compliant kitty when I had a diabetic and I got her into remission with tight control (testing and adjusting dose with glargine twice a day) - but your guy is diabetic for a different reason than “normal” so I’m not as sure about whether trying to check at home regularly will be as helpful. Remission for him will be for reasons other than the usual pancreas-liver-insulin relationship.
Finding a way to keep him off the steroids would be more beneficial for him, and that’s why I’ve gone in to more details about what might be done to check his oral health (FIV and Bartonella testing). If he has ongoing stomatitis issues that aren’t Bartonella related, or for which other treatments dont’ work, the most satisfactory treatment I’ve seen is ultimately removing all the teeth.
I’m gathering your kitties are indoor/outdoor without much ability to keep them indoor-only. If you think they’re carriers of FIV, it’s best they stay inside to mitigate spreading it, and also to keep them healthier by limiting their exposure to all the other feline diseases they won’t be able to fight off with compromised immune systems. But you can only do so much depending on where you live!
Thank you SeaDragonTattoo. It’s really kind of you to give so much of your time and expertise. I will discuss the Bartonella possibility with the vet and see what she says. I am scheduled to bring him back in a few days from now and will report back.
Everything she has said has been consistent with what you are telling me, so that’s very reassuring. She did say that she didn’t think doing the blood glucose testing would be worth it.
Regarding syringes - the vet said that insulin syringes of the best type for a situation like this aren’t available in Jakarta, so I’m using something else (although whatever they are intended for, they seem fine). I’ll keep the OD issues in mind and be super careful not to be sloppy with the dosage. It is such a tiny dosage that it’s a bit tricky - maybe the correct needle would make measuring a bit easier.
Anyway, so far so good - it hasn’t been very long, but at the moment he is doing great. Eating with alacrity at each meal time, alert and affectionate, quite easy to give the shot to. Fingers crossed that this continues!
Sorry, missed the edit window. Wanted to add a few remarks about indoor/outdoor and flea stuff:
Actually both our cats are indoor cats, but lucky ones. Many houses in Jakarta, including ours, are designed with a fully walled-in garden in the middle or back of the house. Ours is bounded by walls that are two stories high, so there is no possibility of escape (or other cats getting in). As “gardens” go, it’s actually not all that nice - there is a small swimming pool with just a small strip of grass/potted plants around the sides, and a patio just big enough for some lawn furniture and a grill. However, it is open to the sky and the greenery helps give it an outdoor feel. The cats enjoy going out there to sit on cushions and sunbathe.
Also, they’ve never had fleas while in our care, but of course Reggie was an outdoor cat for about 3 years before we got him, so might have had fleas in the past.
Had a cat who went diabetic at… 18? I think it was around then. Gave him insulin injections for about a year and then suddenly he wasn’t diabetic anymore. He went on to live well into his 20’s.
Just a quick update since I promised one, and if anyone ever googles this thread looking for diabetic cat stories they may want to know what happened next.
Reggie is doing great - it’s very easy to administer the insulin. The vet did not think Bartonella is a factor although she agreed it was a reasonable question. For now he’s in good shape with small meals, daily insulin shots, and weekly cortisone pills. The granuloma doesn’t totally disappear any more - faint traces of irritation can be seen in the corners of his mouth at all times - but with soft food it doesn’t seem to bother him. He is energetic, has a good appetite, and continues to be sweet. In fact he’s cuddled up on me right now, making it hard to type.
So that’s the end of the story. One of these days his health is likely to spiral downward and we will put him out of his pain when he is clearly uncomfortable. However, we seem to have bought him some time, which he is using to curl up with his humans whenever he can. Hooray for that.