Is it time to let her go: diabetic cat edition.
Four years ago Maggie, my 13 y.o. cat, started vomiting, lost a lot of weight and started avoiding the litterbox. After taking her to the vet, and then a specialist, an ultrasound found a mass that seemed to be on her pancreas. The vet said that it was either cancer, an abscess or pancreatitis. We decided to treat the symptoms as best we can since further diagnosis would require risky surgery.
We gave her stimulants to bring back her appetite, and gave her a new diet that would be gentle on her digestive system. She returned to her peppy self. A year later we rechecked the ultrasound and found that the mass had shrunk and migrated to the kidneys. Her kidneys were in very mild distress, so we switched her to the renal LP diet to try and slow down any kidney failure from being a 14 y.o. cat.
Fast forward to three months ago. Her weight dropped dramatically while eating everything in sight. She was drinking about 30 ounces of water a day, and leaving all of it on my bathroom floor. I bought some doggie diapers to leave on the floor and took her to the vet.
The vet determined that the underlying issue (whether the kidneys or pancreas) have affected the production of insulin and found that her glucose levels were very elevated. We started her on subcutaneous fluids to keep her hydrated and 1 unit of insulin twice a day. Over the last two months her weight is stable and she seems more alert. But she still drinks quite a bit and has escalated her peeing. In the last month she has started using any stray clothes or my bed as a litterbox alternative.
She has been on elavil for the last three weeks and we've increased her insulin twice. The day after we increase the insulin, she uses the litterbox, and then stops until we increase the dosage. The vet hasn't come up with a solution except to wait every two to three weeks to increase her insulin until we find a level that works.
I feel unsure of whether or not it's worth it to keep moving forward. She is more alert, but she is still frail and sleeps most of the day. She shows little interest in keeping herself clean. When she pees in her own bed, she'll just curl back in to go to sleep. Because she's peeing on non-litterbox surfaces her back paws are always covered in urine unless I clean them. She avoids the litterbox as noted, which I know is typically because a cat is in pain. And we're going three months without being able to mitigate that pain, regardless of how proactive we've been.
Her appetite is up and she is still social. She sleeps in her same cocoon bed most of the time (aka not hiding). Because of this, my vet continues to argue that my cat still has a quality of life that most would consider acceptable. In her mind, these are the prime indicators that I should be focused on.
Obviously this is a grey area. I want to hold on to this cat for as long as possible, I've had her since sixth grade. But when she was diagnosed four years ago I decided that I wasn't going to focus on prolonging her life. I was going to make sure the time she had left was positive. My vet seems convinced that I'm considering this decision because I'm constantly schlepping through cat urine, and I admit that this aspect is trying. So I'm turning to all the cat-lovers on the green for advice.
(obligatory pics here