Question Details
Diabetes Mellitus In A Cat
by sophiek - July 25, 2023    View Case Report
Hi Steve,

Moose is my own cat, who was adopted from the shelter 4 weeks ago.
At the time of adoption the only info I had was that he was found as male entire stray and he was very thin (2.6kg). He was desexed at the shelter (no pre-anaesthetic bloods done) and fed Hills I/d wet food due to being underweight and having soft stools. He was also given IM depomedrone due to depigmentation and ulceration of nasal planum.

Moose has diarrhoea, initially very smelly - smell reduced when stopping dry food, but diarrhoea persisted. I switched him on to a raw food diet which he initially ate readily and stools started to become formed. He then went off the raw food so he mainly ate a low carb grain free wet food - diarrhoea returned.

One week after we got him I diagnosed Diabetes Mellitus. He also had a concurrent UTI but rest of bloods WNL.

He was started on 2iu glargine insulin BID and given a Convenia injection. I also started WLT and probiotics, but they were difficult to administer. Over the next 2 weeks he gained weight, diarrhoea persisted, thirst was still high but had reduced, but appetite also reduced. His belly also appeared bloated after eating. He became ketotic 1 week ago and became very unwell quickly.

Repeat bloods show severely low albumin, globulin and total protein. Low cholesterol, low potassium, phosphorus, calcium and creatinine, and a mild non regenerative anaemia. Tentative diagnosis of PLE. Stool sample shows tritrichomonas positive and clostridial overgrowth. Blood glucose unresponsive to dose of insulin.

He has been started on Prednisolone and dose of insulin increased to effect. He is on raw food only diet. 5 days later - blood glucose is responding to insulin, first formed stool passed and much brighter in himself. Bloods due to be repeated tomorrow.

I am thinking of starting him on Agastache Formula to help with the Clostridial overgrowth / Tritrichomonas (which I will also treat with ronidazole). I'm not sure which formula would be helpful to support the Diabetes. He seems to have some Heat signs - excess thirst and appetite, previously ulcerated nasal planum, some Damp / Damp Heat signs - response to raw food diet, diarrhoea with any processed diet, pot belly (though not overweight), response to prednisolone but with adverse effects (increase thirst and appetite), unilateral serous ocular discharge but also quite a few Blood & Yin Deficiency signs - failure of hair to regrow after clipping, very fine dander, discharge left eye becomes very dry and crusty, non regenerative anaemia, low protein levels. So perhaps ongoing Damp Heat has now damaged Yin/Blood?

I am away at the moment so unable to check tongue/pulse/active points. I think WLT still probably fits him best of the Damp Heat formulas, but wondering if you have any other suggestions? Perhaps SMS with added Dang Gui, but not sure of this will give enough GI support, and will taking blood away from the GI tract counteract what the Agastcahe is trying to do by resolving chronic inflammation in GI tract?

Also - I listened to your cancer webinar the other day and you described using the Kan herbal liquid formula and diluting and succussing it. I don't have access to Kan - is there anyway to make a decoction of the NPHC granules and dilute/succuss this instead? If not I'm hoping the prednisolone will at least increase his appetite enough to make giving herbs a little easier...!

Thank you for your help - of course our own animals are always complicated!
Sophie
Replies
by sophiek
July 25, 2023
I forgot to say - Moose is a 6 year old MN Burmese
by naturevet
July 26, 2023
Wow, Sophie, looks like you walked into a real mess. You know what they say! No good deed ever goes unpunished. Or, more likely, the God of Cats saw you walk into the shelter and said "he has to go with her as he is a train wreck waiting to happen, and nobody else can get him through it". I agree with the God of Cats and am happy to help.

My favourite Damp Heat formula for diabetic cats is San Ren Tang. It seems to be strong in insulin sensitizing effects. I use it as well for conjunctivitis.

Regarding the diarrhea, I would see if it fully resolves on the raw (or lightly cooked if he refuses it again?) meat-based diet. If his stool stays formed and he puts on weight, the dysbiosis has effectively been resolved (presumably as the 'right kinds' of bacteria start to grow and outcompete the enteric pathogens that are dependent on processed starch). If not, though, then yes, Huo Xiang Zheng Qi San would be how I would handle it.

As for the damaged Yin in a diabetic cat, my favourite formula for that is Zhi Bai Di Huang Wan. You get the anti-diabetic and GI anti-inflammatory effects of Huang Bai and the benefits of Rehmannia on the bone marrow. It's possible, though, that if you deal with the root cause, which is still prevalent, then the anemia, laboratory abnormalities and poor coat quality will just heal up secondarily. In Chinese medical parlance, the restoration of the Spleen will allow it to start generating Essence once more.

Hopefully this helps you out. Bless you for giving this little guy a fighting chance. I'm betting you can get his diabetes into remission on the raw, once you are able to discontinue pred

Steve
by sophiek
July 26, 2023
Thanks Steve!
Yep, this little guy definitely came to the right house… I figure I’ll be learning lots through him, so all good. It helps that he is a very cool cat that the kids already adore…!

Would you use ZBDHW and SRT together at the same time, or trial the SRT first and see how far that gets him? Would using them together potentially speed up the process?

And have you used HXZQS to treat Tritrichomonas alone, or needed the Ronidazole too?

Thanks again for your help!
Sophie
by naturevet
July 28, 2023
Hi Sophie,

I tend to start things one at a time, so that whether things get better or worse, I can learn from the experience. If you start two things and things go backwards, you may not be able to tell which formula is the wrong one. Since most signs are referable (potentially) to Spleen deficiency and Damp Heat, I would start there. If the dryness signs worsen, add in the Zhi Bai Di Huang Wan.

As for Tritrichomonas, I would personally be comfortable just using HXZQS alone, and then doing follow up testing to make sure it worked

Steve
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