Original Question: I have a 9-year-old neutered male cat. He has been diabetic for almost a year. He was on Lantus for about 6 months but I could not get blood glucose under control. He has had diarrhea for over 8 month and has been on Caninsulin 4 units 2x daily since June 20/17 and it is still not under control. I have him on a 7-day Metronidazole 50 mg 2x daily to try to bring his loose stools under control. He was overweight last year but has lost about 5 pounds and is now at an ideal weight. I have been doing his blood curve every 3-4 week and it is highest in the am 25.5 after 4 units down to 7.7 after 4 hours then up to 32.5 and then down to 28.3 1 1-2 hours after 4 units insulin. I'm hoping that if the diarrhea is under control that the blood-glucose will be better. What do you think? Is there anything else that we can do? - Marlene
Thanks for your question
The quick answer is that you need to have a proper blood glucose curve performed and get the dosage adjusted to control the condition. The numbers you are quoting in your question indicate that this condition is not under control. You need to work with a veterinarian who will help you achieve success here. I don’t make dosage recommendations without having a patient in front of me to examine myself. This is unregulated diabetes mellitus….it needs to be regulated and there is no magic to it. It’s very straightforward to achieve.
In rare cases, I have had to change the type of insulin to achieve proper regulation but again, it’s extremely rare. You should also have your veterinary staff make sure that you are storing, mixing and administering the insulin properly. If you haven’t been shown this then I suggest you request it. I have seen some example of unregulated cases because the clients have been managing the insulin improperly.
I would recommend you get the diabetes under control first before starting to diagnose and treat the diarrhea. I would recommend having your veterinarian perform parasite testing and a focal culture. Consider looking for tritrichomonas. If all of this is negative, I would perform serial deworming and begin an antibiotic trial and support with vitamin B12 and probiotics.
I hope this helps.
Dr. Clayton Greenway
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