What would you do?

RE: What would you do?

Lucy Fleming — Wed, 13 May 2026 09:06:51 GMT

[quote userid="5012" url="~/f/clinical-questions/31345/what-would-you-do/248821#248821"]

Maybe you would like to host a thread on managing feline diabetes on a budget?

As David points out, nobody really wants DM cases, but as a locum they are even worse/harder, because practices and even different vets within the same practice vary greatly on how they approach and manage them

[/quote]

I was pleasantly surprised with the recent iCatCare consensus statement on managing feline DM - a lot of focus on monitoring weight and clinical signs to assess glycaemic control!

You could almost fall into two management camps for these based on owner wishes - hands-off, QOL focussed (low cost) management for those preferring that, Vs continuous glucose monitor placement and aiming for tighter control for those that are more data-driven, aiming for remission etc.

RE: What would you do?

Anthony Dennison — Mon, 11 May 2026 07:52:55 GMT

[quote userid="8991" url="~/f/clinical-questions/31345/what-would-you-do/248814#248814"]In a slightly related note, are people using Senvelgo much? Had first normoglycaemic DKA on it today after 4 weeks (n = approx 20) incidence is supposed to be about 10pc, are people seeing that? [/quote]

A few cases. Mainly for all the old ladies as they're less likely to be injecting BID. Not seen a DKA case yet, but we've got less than 10 cats on it atm

RE: What would you do?

Clive Ansell — Fri, 01 May 2026 09:46:13 GMT

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248818#248818"]That's a lot cheaper than I could do it for. Hence a urine sample only as this alone would let you know if diabetic (obviously can be other causes of glucose in urine but rare) and then options can be discussed[/quote]

Fair enough, I would offer the same.

The point of my post was that I am working in small independent practice, where prices are lower than the average, and I could run blood and urine test, and reach a diagnosis for less than £150 - cheap really.

Depending upon the client, I would be equally happy just prescribing metacam, or as youu suggest urinalysis first.

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248818#248818"]The aim with this is to get people thinking about possible differentials and prioritise them and what tests are or aren't going to change what you do and think about what is the minimum I could do to help this cat [/quote]

You did just that, thanks.

Maybe you would like to host a thread on managing feline diabetes on a budget?

RE: What would you do?

Michael Woodhouse — Thu, 30 Apr 2026 22:58:02 GMT

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248810#248810"]meds via written prescription[/quote]

I find this part so triggering. Thyronorm is cheap and it would cost the owner vastly more paying online price plus a prescription fee versus buying a bottle from me. No risk of prescription fraud, no hassle for extra paperwork etc.

I do like the sensible type of thread, thanks Kate Richardson

I appreciate that I don't do a huge amount of small animal work, but I confess I hardly ever see diabetic cats. Lots of arthritic ones, some Hyper T4, some kidney failure, some cancer. Honestly I don't think I will have diagnosed a cat with diabetes for 10 years.

RE: What would you do?

Kate Richardson — Thu, 30 Apr 2026 13:51:37 GMT

[quote userid="5012" url="~/f/clinical-questions/31345/what-would-you-do/248816#248816"]My initial advice of urinalysis and basic blood work would have clinched the diagnosis of DM and hyperT4, and all for less than £150 including the consultation. Job done[/quote]

That's a lot cheaper than I could do it for. Hence a urine sample only as this alone would let you know if diabetic (obviously can be other causes of glucose in urine but rare) and then options can be discussed

[quote userid="5012" url="~/f/clinical-questions/31345/what-would-you-do/248816#248816"]Given costs were an initial concern, will the clients proceed with treatment for DM, HT4 and OA?[/quote]

I didn't say they had no money, just not a lot! But if DM is ruled out, then costs of tx (minimum of OA tx only) can be discussed

The aim with this is to get people thinking about possible differentials and prioritise them and what tests are or aren't going to change what you do and think about what is the minimum I could do to help this cat

RE: What would you do?

Clive Ansell — Thu, 30 Apr 2026 08:00:57 GMT

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248812#248812"]My main take from this was no -one considered diabetes [/quote]

I had.

Losing weight and drinking more, would place diabetes mellitus high on the list of differentials for me.

My initial advice of urinalysis and basic blood work would have clinched the diagnosis of DM and hyperT4, and all for less than £150 including the consultation. Job done.

Given costs were an initial concern, will the clients proceed with treatment for DM, HT4 and OA?

RE: What would you do?

David Mills — Wed, 29 Apr 2026 19:34:45 GMT

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248812#248812"]My main take from this was no -one considered diabetes but otherwise top points!! [/quote]

No one wants to diagnose diabetes, let's be honest

It's my least favourite disease in veterinary medicine and I do everything to avoid it if at all.possjble.

Unfortunately it makes up the 4 choice old cat losing weight bingo card - CRF, HT4, DM, cancer.

In a slightly related note, are people using Senvelgo much? Had first normoglycaemic DKA on it today after 4 weeks (n = approx 20) incidence is supposed to be about 10pc, are people seeing that?

RE: What would you do?

Beats — Wed, 29 Apr 2026 18:27:19 GMT

Urine sample was first thing done so DM ruled out at very start of thread ;-)

I agree great thread thanks for posting!

RE: What would you do?

Kate Richardson — Wed, 29 Apr 2026 17:32:54 GMT

[quote userid="5012" url="~/f/clinical-questions/31345/what-would-you-do/248811#248811"]many younger colleagues are horrified that I don't run bloods every month initially, then every 3 months once stable. Even older cats that need sedating every time still seem to get monitoring bloods. [/quote]

Not just younger colleagues.

I ideally like to run a blood after 4-6 weeks mainly to check no side effects eg liver toxicity/anaemia/neutropeania rather than the T4 level as this does happen occasionally even in a cat that seems clinically well, but its a discussion to be had with the owners. And if all is normal I rarely run a 'monitoring' blood again Otherwise, its asking is doing bloods going to change what we do. In s clinically stable cat, unlikely. Weight loss or no gain, then yes it may help, but if classic hyperthyroid (and even if not) a small dose increase can certainly be trialled to see if gains weight/HR drops. Sedating for bloods in a clinically stable cat is just wrong IMO

My main take from this was no -one considered diabetes but otherwise top points!!

RE: What would you do?

Clive Ansell — Wed, 29 Apr 2026 16:26:10 GMT

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248810#248810"]So I thought I'd give my plan [/quote]

That was a great exercise - thanks .

Good to see we would almost all of got to the same point with slightly differing approaches- more than one way to skin a cat so to speak.

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248810#248810"]Monitoring the thyroid will be done clinically ie weight gain going forward as long as cat is well[/quote]

I do this quite a lot, often with weight and heart rate checks as nurse appointments, then seeing a vet every 6 months for ongoing meds.

many younger colleagues are horrified that I don't run bloods every month initially, then every 3 months once stable. Even older cats that need sedating every time still seem to get monitoring bloods.

RE: What would you do?

Kate Richardson — Wed, 29 Apr 2026 13:31:40 GMT

So I thought I'd give my plan and then start a new one Arlo Guthrie

So main concern is the reduced mobility but is this due to arthritis- yes most likely. However, something is driving this cat's appetite given it's teeth are awful plus it is losing weight despite eating ok- I always double check appetite as sometime with bad teeth they are eating frequently but only small amounts at a time, so clients see this as eating ok, whereas it can be due to dental discomfort.

So my main concern initially was to rule in or out diabetes mellitus as this is a game changer and the poor mobility could be due to diabetic neuropathy/weakness/hypokalaemia Agree that hyperthyroidism can wait given the HR is normal, tx of neoplasia unlikely to treat, GI disease possible, but would include lymphoma on that list as well as EPI.

So I would do a urine sample as a minimum- as this will rule in/out diabetes. In this case it was negative for glucose and ketones, (phew) so I went for a pain relief trial (meloxicam) as cat was eating ok.

Cat was so much better after a month of treatment and had stopped urinating indoors, still drinking more and weight stable but no gain

Owners were so happy with how he was doing so we discussed the options and ran some bloods (generally the profiles are cheaper than picking an choosing specific tests, so ran haem/basic biochem and T4). Cat was hyperthyroid so have started treatment now, meds via written prescription and if continues to do well a dental is planned as the next step. Monitoring the thyroid will be done clinically ie weight gain going forward as long as cat is well

RE: What would you do?

David Mills — Fri, 24 Apr 2026 11:52:09 GMT

Treat the presenting issue, OA pain, meloxicam.

Discuss likelihood of hypert4, renal, neoplasia. Estimate for basic bloods but not essential there and then. Outline costs of hypert4 treatment (no point in testing if can't afford to treat).

Let the owners think for a few weeks whilst the cat gets pain relief.

RE: What would you do?

Clive Ansell — Fri, 24 Apr 2026 07:52:11 GMT

I've given this more thought.

Where I am currently working, I could run a basic pre GA blood profile (Urea, Crea, ALT, ALKP, Glob, Glu, manual PCV) for £65 and in house urinalysis £12.50 or including microscopy £20. The blood sample would usually be taken at the time of consultation, and if not fully booked the owner could wait to discuss the results 30 minutes later. So, with the consult fee (£60) all in for less than £150 we could get the info we need and come up with a care plan. That's a damned good service at a very reasonable price (probably undercharging if anything)

If owners want to just trial metacam, just as good, but I would prefer the blood work first.

RE: What would you do?

Arlo Guthrie — Fri, 24 Apr 2026 07:04:58 GMT

Hold that thought, I'm just posting in a Facebook group to see if any young vets are there and want to come and join in!

RE: What would you do?

Elizabeth — Thu, 23 Apr 2026 22:17:13 GMT

So Kate, what would you do? I’m with Michael so far.

RE: What would you do?

Kate Richardson — Sat, 18 Apr 2026 17:26:10 GMT

Well Michael and Ben are younger than me but that’s not saying much

RE: What would you do?

janine redman — Sat, 18 Apr 2026 11:25:50 GMT

No younger replies yet ?

RE: What would you do?

Kate Richardson — Fri, 17 Apr 2026 07:23:44 GMT

Thanks for replies so far from the old duffers

Any younger vets out there with their thoughts?

This is not to criticise anyone, it is to help develop a contextualised approach to cases and gain confidence that you can mange cases like this with confidence and no fear of retribution

RE: What would you do?

Michael Woodhouse — Thu, 16 Apr 2026 01:15:21 GMT

In this scenario happily start on Loxicom and advise move onto something like a moist kitten food, see back in a month to review and weigh. No concerns with kidney issues and NSAID, if they make it worse, it's headed for the freezer.

After a month see how moving, see if weight and urination improved, decide if we've done enough or want to go further. I'd like some bloods doing, but not bothered if not done straight away. If cat coping clinically, don't mind if never done.

I've seen many cats like this do very well with just pain killers, if its hyper T4 now, it still will be in a month. If we spend too much now and find lots wrong, we increase the likelihood of ending up admitting to the freezer.

RE: What would you do?

Ben Walker — Wed, 15 Apr 2026 18:53:31 GMT

Great scenario.

We see plenty of owners PTS at this point, so explain it’s a fair choice.

Priority for me is pain management. It’s the owner’s concern and I‘d wager it’s the thing the cat cares about the most. I’d go standard dose NSAIDs.

Urination indoors likely from pain or PUPD. The latter might make it hard to control and we could check a USG, dipstick, and sediment if they want an indication that it’ll be trickier (might inform a PTS decision).

Agree the weight loss is my next concern. Whatever the cause, it’ll limit how long he has left. Can open up a can of worms pursuing though. Flag the teeth but I’d leave them unless we’re confident the weight loss is explained and addressed.

Problem is, most of the treatments we might decide on in pursuing the weight loss have monitoring expenses beyond just the cost of meds. Is that on the table after quoting for long-term NSAIDs?

RE: What would you do?

janine redman — Wed, 15 Apr 2026 17:52:40 GMT

I would see if owners willing to go for basic screen and thyroid though history doesn’t point hyperthyroid and a free catch urine sample at home or cystocentesis if patient amenable . If pain is the problem then I would address that first if renal and hepatic parameters ok.

after that it depends on lots of factors as the painful mouth is another welfare issue but dependant on renal and hepatic risks

if really unable to afford much then a urine sample first and then meloxicam if nothing else

RE: What would you do?

Clive Ansell — Wed, 15 Apr 2026 15:19:18 GMT

Concerned re weight loss. so would adv basic blood work (basic biochem, TT4 and PCV as minimum), urinalysis, and clip nails to make more comfortable.

Then, come up with a plan based on results, +/- what sounds like much needed dental work.

If can't or won't afford investigation, DMV or NSAID and suck it and see, or offer PTS

(if they love their cat as you say, they would find the fairly small amount of money for basic blood work)

RE: What would you do?

Beats — Wed, 15 Apr 2026 15:16:33 GMT

Nwl shcf- profile

RE: What would you do?

Kate Richardson — Wed, 15 Apr 2026 15:07:38 GMT

Sorry meant to put no palpable goitre, will edit it!

More specific with 'bloods' please

RE: What would you do?

Beats — Wed, 15 Apr 2026 15:05:10 GMT

Feel for a goiter and check the urine (bladder usually full if drinking more and i just stick a needle in). Then either bloods or start on low dose metacam with caveat the kidne ys may not be great, or consider 0.2ml depo instead. This assumes I don't think is simply time for euthanasia and that is what owners have come for which would be pretty common.