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
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
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
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
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
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
Contributed July 2002
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