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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 32880
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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I am tormented by the thought I missed the signs my cat was

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I am tormented by the thought I missed the signs my cat was diabetic. We had him euthanised last monday due to recurring nystagmus. His health was not great but he was on metacam for arthritis and had had steroid injections for wobbliness. I had overlooked his peeing sometimes indoors as due to ageing nearly 13 and the quantity he was passing seemed execessive but I thought he was just holding on to it as he was a nervous cat and afraid of others to go outside to go. He started to sleep much more and episodes of weakness holding his head down. The vet had told me that if the suspected vestibular disease kept returning then we were at a crossroads. I had looked at the symptoms of diabetes when I became concerned for him at home and rubbed honey on his gums which appeared to rouse him. I took him to the vets who did bloods and said the results were not conclusive but thought his result of 7 did not suggest diabetes even though honey had been given. He over the weekend had another funny turn with nnystagmus and we ruxhed him to the vet. Seeing his distress she advised we euthanise him saying that nystagmus was not part of diabetes. But i have since read that undiagnosed diabetes can lead to neuro symtoms. I have to say he did not have excessive thirst at all . I am beside myself with the grief of loosing him plus the guilt of euthanising him when he could have had treatment. Thank you
Aloha! You're speaking with Dr. Michael Salkin
Please be assuaged that if he weren't polydipsic (increased thirst) and polyphagic (increased hunger) and had a blood sugar of 7mmol/L, he wasn't diabetic. I might be concerned about diabetes if his blood sugar were twice that value although simple stress can elevate blood sugars to that extent as well.

His polyuria (increased volume of urine) and neck weakness - usually due to hypokalemia (low serum potassium level) - was more likely due to early renal insufficiency at his age. Nystagmus is a symptom of vestibular (balance) disease. We attempt to clarify if the nystagmus results from the idiopathic (unknown cause) vestibular syndrome of cats, a peripheral vestibular disorder involving the inner/middle ear(s), or a central vestibular disorder involving the cerebellum and/or brain stem. At his age and because repeated episodes of nystagmus were seen, a central vestibular disorder is most likely and an underlying brain tumor - a meningioma, usually - is often found.

I understand your concern but you're not to chastise yourself. Instead, you should be lauded for the excellent care you've provided him. Please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.

Many thanks for your response. I was convinced the honey rubbed on his gums had helped him come round from a coma/sleepy seizure like state and would a cat always seek extra water with diabetes? and also forgot to say he had no real loss of weight. He had a good appetite for wet canned food but drank no water offered. He did seem to have some constipation though and had long since given up grooming. I would appreciate your comments on these issues. Many thanks.

Honey would make an unregulated diabetic worse - not better. It would elevate an already elevated blood sugar. Yes, even as poor a water drinker as most cats are, you'll see them at their bowl more often when they're diabetic. The fact that he didn't lose weight also belies the diagnosis of diabetes. Polyphagic diabetics lose weight in spite of taking in excess calories. Geriatric constipation is quite common and likely due to geriatric cats running around borderline dehydrated. Cats find it difficult to keep themselves hydrated properly; they're desert animals unaccustomed to drinking. Poor grooming appears to be endemic in geriatric cats. It's likely due to discomfort while grooming; osteoarthritis is common in geriatric cats.

You're quite welcome. Please continue our conversation if you wish.
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Customer: replied 3 years ago.

I am continuing to agonise over my cats euthanasia though in my heart I could see he was having a hard time. Guilt is persisting that I should have done more, more tests etc. He became very ill with a liver condition 2 years ago ,treated and put on Hills diet l/d. As I have another cat he frequently ate her food in preference after only eating a little of his own, so I wish I'd been more strict do you think this liver problem may have been a precursor to his ageing and the problems that led to his demise. Im sorry to not have included this before. Thank you

I believe that we make too much of a fuss over special diets for particular maladies. I don't believe that his eating your other cat's food was a factor. Unfortunately, I have no way of knowing whether or not his liver was a factor at this time. The symptoms of liver disease aren't pathognomonic (specifically indicative) of liver disease and include anorexia, lethargy, vomiting and diarrhea, jaundice, and increased thirst.
Thank you for your kind accept. I appreciate it.

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