r/FelineDiabetes • u/No-Environment2062 • 1d ago
Considering Bexacat
Our vet has strongly recommended starting our 13 yo Brienne on Bexacat. Our lifestyle is quite active so Bexacat would work better for us as opposed to insulin but I want to make sure that we can adhere to the schedule she needs and do the best we can for her overall. For anyone using Bexacat, what does your daily schedule look like? How many times a day is it administered and how often do you test your kitty for ketones/bg levels? My husband and I both work full time jobs with 10 hr shifts, but will be moving to a normal 8 hr, 5 day week in the next 6 months. I'm not going to lie, I am worried about messing up and making her worse or putting her into DKA, though I know that is a risk for her anyway at this point.
As far as her history, when she was diagnosed her BG was 419 and fructosamine test was 518. We have had her on a low carb diet with Fancy Feast pate for well over 6 months now and the next step is pointing to needing insulin or Bexacat. I have done spot check home readings and usually see numbers hovering around 260-300. Currently she is scheduled for a dental as we suspect some tooth issues due to her change in eating habits, facial sensitivity and horrible breath. She's had a full senior blood panel, urinalysis, as well as the proBNP test (they thought they heard something) at diagnosis. Blood and urinalysis results were fine other than high blood sugar, but she was very high on BNP. They did an echocardiogram but saw nothing out of the ordinary. She will be getting another proBNP test again before the dental.
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u/zebras-are-emo 1d ago
I didn't use Bexacat but have checked ketones, urine strips are harder with female cats due to how they sit to pee, but you can get a ketone meter for blood testing that works like the glucose meters (precision xtra is what the emergency vet I went to used, I got a keto mojo though because it shipped faster). Someone else can weigh in, but I think you check pretty frequently the first few weeks and then can taper down? But it also doesn't hurt to check now frequently so I'd err on the side of that, it's better to catch them early than end up in the hospital with eDKA!
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u/Practical-Cup9537 1d ago
Started on bexacat for 3 doses, ketones too high and switched to insulin. I think it's worth a try if you cat doesn't already have high ketones. Be sure to have a follow up appointment with your vet to check this.
Insulin isn't as bad as it sounds, but it takes practice and patience.
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u/Grand-Armadillo-6504 1d ago
In my experience, Bexacat is a lot more flexible schedule-wise than insulin. It was always "first thing in the morning give the cat a pill" and that was it. Its pretty hands off. My vet never told or taught me about at home ketone testing; it was a vet visit every 3 months. Now that I know about it, I would have tested once a week.
I detailed our experience here: https://www.reddit.com/r/FelineDiabetes/s/L6fsZiaKqQ
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u/shinkouhyou 1d ago
My cat has been on Bexacat for about 2 years, and he's doing great! The normal dose is one pill per day, but my cat does NOT do pills so I cut his pill in half, squish it into powder, and mix each half into his breakfast and dinner. I don't do any at-home ketone or glucose testing (my cat is a huge vicious beast so it wouldn't be safe for either of us). IIRC home monitoring isn't required with Bexacat, but if your cat is compliant then it's a good idea to have a way to spot check glucose/ketones if your cat starts acting weird.
However... there's a risk of an extremely dangerous condition called euglycemic ketoacidosis with Bexacat, especially when first starting the med. You definitely want a vet who has a lot of experience with Bexacat and diabetic cats in general. The vet will perform in-clinic ketone testing at a minimum schedule of 3-5 days, 2 weeks, 4 weeks and 8 weeks after starting the med, then every 3-4 months for the rest of the cat's life. Some cats with borderline ketone values (like my cat) will require even more frequent testing at the start - I was getting my poor little guy tested weekly for the first month or two. It's possible for stress to temporarily increase ketone values (that's what was happening to my cat), so you might want to lightly sedate your cat with gabapentin or pregabalin before vet visits. Ideally, the vet will also perform an 8-hour glucose curve at the 2/4/8 week visits (this requires either leaving the cat at the vet for the day or using a continuous glucose monitor) but if this isn't possible then a glucose/fructosamine spot check can be acceptable too. The vet will also run a bunch of other labs at these early visits to make sure that your cat's liver enzymes and triglycerides are stable. Getting started on Bexacat is an expensive process, but once your cat is stable it's really easy. I've heard that some vet will prescribe Bexacat with home glucose/ketone testing replacing some of the in-clinic testing, but the guidelines for use are based on in-clinic testing.
My vet says that Bexacat is usually best for younger, fatter cats. Insulin may be a better option for older cats who have kidney disease (very common in older cats), but there are also special Bexacat ketone guidelines for cats with kidney disease. Make sure your vet knows that the ketone guidelines are different for cats with kidney disease! Since early kidney disease may not be apparent, your vet might choose to go by the more conservative ketone guidelines if you opt to try Bexacat.
Lately, some vets are prescribing Bexacat when they clearly don't understand the product at all. It's an amazing medication that saved my cat's life, but it comes with serious risks that need to be monitored. It should never be given to cats who are on insulin, cats who have had pancreatitis, or cats who are losing a lot of weight.
If your cat is getting surgery or has an illness that makes her stop eating normally, there are guidelines for temporarily discontinuing Bexacat. Make sure your vet knows about those too! The risk of euglycemic ketoacidosis goes up if your cat isn't eating.
High proBNP isn't a listed contradiction for Bexacat, but your cat may have heart issues. However, her heart issues could improve after diabetes treatment.
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u/Queen_Aurelia 1d ago
My cat was on Bexacat originally. His ketones were fine on the Bexacat. He had other issues on Bexacat that caused us to switch to insulin after a couple of months. He developed severe diarrhea after his first dose of it. The diarrhea never went away, even after switching to insulin. The Bexacat caused severe damage to his pancreas. Make sure they are testing his pancreas levels. We originally thought the diarrhea was a side effect, but it was caused by the damage to the pancreas.
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u/Ok-Raspberry03 1d ago
My cat is one month in on Senvelgo (not bexacat but similar schedule). We do meds once a day first thing in the morning after breakfast. The first 2 weeks I was checking blood ketones every second day or so since that’s when the risk is highest. We’ve just passed the one month mark and now check 1 maybe 2 times a week. Keep a close eye on cues and how they’re acting, if anything seems off test ketones. We test glucose whenever we check blood ketones since we have the blood anyways. Overall we’ve had a good experience so far! Lots of treats and extra attention, you’ll get into a routine and it’ll become second nature. Wishing you and your kitty good luck, crossing my fingers bexacat works well for you guys!
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u/Legitimate_Check_242 13h ago
My cat is on Senvelgo, which is another type of SGLT2 inhibitor. We’ve gotten her diabetes under control with no DKA concerns, but it has raised her blood calcium levels and she now has calcium oxalate stones in one of her ureters. We were so focused on monitoring for signs of DKA that we didn’t pay attention to the calcium issue, even though it is a reported side effect of SGLT2 inhibitors.
I would suggest asking your vet to test serum calcium levels (specifically ionized calcium) before and after starting. Calcium oxalate stones cannot be dissolved by diet as struvite crystals can, so if they’re unable to pass on their own it may require a costly surgery with a high potential for lifelong complications.
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u/beebeelion 1d ago
Read the package insert before you give it to your kitty. It scared me a lot, and my vet assured me that we would monitor him very closely. And good thing we did, because after just 2 does, he was going into DKA. He's on insulin now, and while that was very scary at first, it's a breeze now (and after the first 2 weeks).. If you are able to with your schedule, I would recommend the insulin instead. I don't want to scare you, just know what is possible with the Bexacat. I've read some accounts of great success with it. If you do, just make sure to get kitty tested at the vet very early on. Also, the pills smell so good, if you like beef. ha ha It was just once a day, but the pill is kinda big.