? Help, input needed - Panc, IBD, Diabetic and starting insulin & pred

good evening, looking for ant and all input I can get. My baby Pablo was diagnosed with diabetes from a few high blood glucose and urine test. Regular vet and IM vet both agree starting lantus is the right thing to do. My boy has chronic pancreatitis that seemed to be manageable until mid June or July. He was on prednisolone around this time. Thru also put him on short course of high pred (3x day) in June. Late July he was switched to budesonide. His glucose was always normal or slightly normal until June at which time it started to climb. After the drop in pred from 3 to 1 pill his glucose was more normal -195 -225. Since starting budesonide in late July glucose numbers high. I'm not sure if this is a coincidence or not. He had a good and normal appetite until mid to late June. Around mid to late June appetite ok, and enough to keep his weight relatively the same. Since starting budesonide his appetite has tanked (I attribute to this but not sure if related to glucose increasing as well). Since approx July 27 when transitioned he has little appetite with appetite stimulants (which he has been on for some time). Often times I have to prompt him to eat and in the last few weeks have had to resort to assist feeding about half of the time to make sure he's getting enough. Vet said today wants to start pred if not eating better this weekend along with his insulin meds and stop the budesonide. Thoughts and input really really appreciated.

 

If Pablo needs pred, then that's what he needs. We work the insulin dose around that. My girl was on budesonide and it helped her, but ECID, each cat is different. And my kitty couldn't take prednisolone. Usually appetite will go up with unregulated cats and higher blood sugars.

Have you started home testing the blood sugars yet? That 's a good thing to learn before he starts insulin. Has the vet discussed a starting Lantus dose? You may have to go to a higher dose with pred on board. That's OK. We have had a few kitties here taking pred.

If you haven't already, read the yellow StickyNotes at the top of this forum. We use two dosing methods here, Tight Refulation and Start Low Go Slow. Read those two documents and see if one seems more suited to you. You can always change later if you want,

 

Have you had the pancreatitis test? There is a specific test for it.
Pain will make them want to eat less.

And have you done any of the other tests such as ultrasound, see what's going on inside.?

 

Thank you for the info. Yes mine is on budesonide but doesn't help him at all. I'm going to start home testing today with the help of a friend. We dud discuss lower dose to start but may need to be adjusted if we do pred. One other doc said that adding pred with everything may shorten his time, I hope not but we need him to eat. His bg seemed quite lower on one dose of pred, but that was about a month ago

 

Yes he's had several panc spec fpls and ultrasounds. He looked like he was on deaths door in march with a panc value of 5. He's got two to theee times that number since June but looks nothing like he did in march. Also several ultrasounds, has active panc infosmstton, ibd vs scl (thru said more likely ibd). One vet though others have not have recommended adding chlorambucil into mix as well but unless he has endo or surgery which I don't think little body would take, or would be hard recovery for him likely, no way to confirm on that one.

 

Have you tired an appy enhancer to see if that will get Pablo eating? Mirtazapine or Cyproheptadine (both are prescriptions from the vet). Gizmo was put on steroids for a month (1/day). He was diagnosed with diabetes shortly there after.

That isn't too bad. Got to get him eating and control the pain. Some of here use cannabis (capsules and/or oil), which really seems to help with both the pain and appetite. Is he getting sub-q fluids? Sometimes that helps (my Gizmo is not, nor has he, except at the vets). Lots and lots of water in his wet food (think soup).

Have you input the lab results into the spreadsheet (see lab tab)? If not, I suggest you do that and have our resident lab reader (Marje) take a look to see if she sees anything off.

 

Yes he gets all of the above, with the exception of the cannibis capsules or oil. I don't know much about that or hadn't heard of that or how it works where to buy, how a persons gets or recommended. I have not input his labs into the sheet, but can do so.

 

His panc values since mid to late June are around 10-15 and he walks around normal but obviously is slower and less active. When he was at 5 he was on deaths door, so they told me that every cat is different in terms of how panc values affect them and when and management etc of them, I guess it would seem so with his numbers. However, before June he was eating decent/good and now is not

 

Tagging @carfurby

Can you post the eating suggestion info?

 

Reading your signature you indicate appy tanked after starting pain meds. You may need to back off that to get him started eating. I did with Gizmo. Then I cut back the dosage. It is a learning experiment. Going to have to see what works.

How much is Pablo eating? How many oz yesterday?

 

if you haven't read this, it's a good read....
primer on pancreatitis

 

Appetite tanked after starting budesonide and glucose started going up around same time. If I put pain meds that's in error. He only gets pain meds as needed and not often unless in obvious pain. If eating on his own, honestly not much other then nibbling on small hard food throughout the day (I usually have 1/2 cup out and it takes him 2-3 days to go through it). I most have to prompt him to eat. When I do, on average he will eat about 2-3 oz a day. I supplement with assisted feeding if it isn't enough .

 

Nope, my error. I read Bupe (which is pain med), you have budesonide. Sorry about that.

It took Gizmo about a week to start eating on a regular, reliable basis. I too had to force feed for a little bit.

What foods have you tried? My go-to was Fancy Feast Turkey and Giblets. It is low carb and that was what he liked. I went back to it temporarily to get him to start eating. Does Pablo have a favorite food (that he ate well pre-pancreatitis)?

I would give pain meds (small dose) on a regular basis. See if you can break the cycle. The cannabis I like and Gizmo will take (mixed with food) is this:

https://cannacompanionusa.com/

There is also an oil (different product), but he doesn't like is mixed with his food.

Have you tried mixing some water from tuna (human food in can), in water not oil, on top of his food?

Try a can of this? Small amount.


Try putting food on a flat plate (vs a bowl).

Just throwing out suggestions.

 

Here is info on a slurry that has helped other sick kitties.
Appetite: Liver Shake Recipe

And a link to recipe for bone broth
http://www.ibdkitties.net/bone-broth/

ETA-found the link with suggestion on getting them to eat....
How to Stimulate Kitty's Appetite

 

I'm glad you found the link. I've been out all day.

I hope you can get your kitty eating better and balance everything out. Sending prayers.

 

cats are notorious for hiding their pain until it's really really bad.
Imho, you should give the pain meds consistently for a week.... and see if it makes a difference.
I don't know what dose of pain med you have, if its a full normal dose, you could reduce it.
Since my Shadow couldn't tolerate pain meds very well, I had her on the lowest dose possible of Bupe to keep the edge off but she could still function and not be all loopy/dysphoric.

 

Welcome to the board! It sounds like you've been doing a huge juggling act. FWIW, if the cyproheptadine isn't helping with appetite, have you tried mirtazepine? You can't give the cypro and mirtazepine together -- they counteract each other. But, if one isn't working, the other may be worth a try.

Is there any concern that Pablo may be nauseated? That may be why he's not eating.

One appetite "enhancer" that has worked for my kitties is sprinkling crushed freeze dried chicken on their food.

How can we best help you with managing Pablo's diabetes? As Wendy noted, it's best to not worry about the steroids and Pablo's diabetes. The insulin dose can be worked around the other meds.

 

@Sienne and Gabby (GA) He doesn't seem nauseated and seems to do better off of anti nausea meds. But I can try that again as its all been trial and error. When you say crushed freeze dried chicken on food, do you mean you cook the food, freeze it and then put it on top of the food? For a while I was cooking chicken etc, but he doesn't seem to like that now. I've tried mirtazapine in the past and it has made him climb the walls (also tried about a month ago and it did the same). I can ask the vet about trying it again though.

 

@rhiannon and shadow (GA) yes I asked for low dose of bupe to see if that helps as well. have been giving it for the last night or two, my cat is the same and sensitive to it and mirtazapine it seems.

 

thank you very much!

 

Did it get him eating? Sometimes you have to weigh the side effects.

Freeze dry treats (these are Gizmo's favorites, especially the duck liver)
https://www.chewy.com/purebites-duck-freeze-dried-dog/dp/35019
https://www.chewy.com/instinct-by-natures-variety-raw/dp/117336

 

I don't think it did but it's been a while since like July I can ask the vet about trying it again. Thank you regarding the freeze Dried info!

 

I actually do have some of those mixers, and have been trying to use them (didn't realize that's what they were until I saw the pics from the link you sent). Thank you again!

 

Try and smash them up and sprinkle on top (push them down a bit into the wet food).

 

I didn't like the mirtz either.... Shadow would meow constantly for food.... eat her food.... I knew she was full but the meds just
kept her begging for more..... it doesn't seem to have a satiation point.

Once time the vet insisted that I try it first, I did, and called back the very next day and said, nope, I want to try the ondansetron.
They hadn't heard of that one but she wrote me a prescription, I took it to the grocery store and filled it and it worked
wonderfully.

 

Late to the party but been doing the same as you for about a year now. The IBD, when not in control really does make their tummy turn off. Jones is on Cyproheptadine and I found it worked better in getting him to consistently nibble. I have also gone through quite a few brands of cat food to entice. And it changed every time he had a flare up. Kitty may associate the food with feeling bad. You may find that the wet food is easier to get nibbles down. Jones is also on metronidazole not only for diarrhea but for anti-inflammatory properties. The cerenia is for nausea...which is a by product of the IBD and pancreatitis. The pred may also cause some nausea if they are not eating a lot.

In the end I think you will find you have many options to try. Just don't make my mistake and do a lot of changes quickly. You might end not knowing what works and what doesn't. Document what you changed and when. Give it a couple of weeks to see the difference.

As mentioned the steroids can cause diabetes in cats. In fact if it wasn't for the pred Jones would probably be OTJ. The best advice I can give here...is manage the dose around the medication and don't think of the goal as remission but tightly controlled.

Best of luck.

 

@Tracey&Jones thabk you for the info, this is very helpful!!! When you say when the ibd isn't in control it makes their tummy turn off? How do you manage the ibd? I think despite what vets may or may not say that his main issues are panc and ibd. How much cypro do you give? My boy is about 14 lbs normally. I too have gone through countless foods to entice, I literally have two huge plastic bins as it changes often. My boy has never had diarrhea but the opposite where he used to cry when he pooped until starting lactulose. He still does on occasion but not as often (until the last few days). Interesting about pred if not eating a lot. I didn't know that. Such a good point about not making too many changes someone also said that to me today. How do you manage it all? I'm single and it's a full time job, I've actually asked to start working from home occasionally to help manage. I may have to go back your cerenia even though he hates it. Do you find yours ears enough during the day? They just started him back on pred and not sure how long I'm supposed to wait to see a change and if supposed to start insulin at the same time. They said they wanted to see how he was eating restarting pred again today. Thank you again and appreciate your input!

 

Also do you do:give pain meds if/as needed?

 

it's better to be consistent with the pains meds too. Even if it's a small dose, it takes the edge off.


With ibd, you will likely want to find a new protein, a novel one that he hasn't had before.
He's likely got a food sensitivity which isn't always easy to figure out.


and have you see this
primer on pancreatitis

 

Hello Nicole and welcome. Phoebe has IBD and Panc on top of diabetes. She gets gabapentin, for inflammation and pain for IBD, and takes bupe and canna, for pain. Her appetite is only a small issue thank goodness, but it only became a little problem after we started the cerenia and zofran. She takes it everyday for nausea and vomit control. Without it she is a terribly sick kitty. Sorry you have to go through this as well. Before you know it , it will become second nature and just part of your routine. Flare ups cause some issues sometimes, but you roll with the punches. Head bumps and for you

 

ECID is different.

I give a 1/4 tab twice a day. I found it worked better than mertz - that made him howl for two days and he did not eat really except the day and half out of the three.

The prednisole to me is a catch 22, he needs it to help the inflammation but it may also cause some tummy upset. This is an assumption on my part as well as just watching Jones. I was just diagnosed with Chron's, which is similar in nature and put on pred. I was put on a high dose antacid and told to eat something with it and about 2 hours after. So I am kind of assuming it is the same thing goes with Jones. This is where the cypro seems to work better as about 20 - 30 mins after administration and he has a snack. So just through observation and using my own experience - the theory seems to work. It is through my own experience from the last few months - when you intestines are inflamed and sore - you stomach literally shuts down. I was not hungry at all. I ate very little and only because I knew I had to! Your kitty doesn't really get that part of the equation.

ECID - IBD will be managed through the medication and limiting any food triggers. and for me finding that Jones was allergic to tuna helped. And time, lots of time. After about a year, I think we may onto a combination that works. If you are interested to see if he has anything he shouldn't be getting there is a simple test. You see a link in Jones signature that shows the report. You can get it through groupon. I found the money spent worth in order to compare ingredient list for any of his red zone items.

The cerenia helps Jones but I now wonder if plain pepcid would work as well. I think that would be worth a discussion with the next IM visit. I actually get size 4 capsules and put his meds into them, I find it easier. I also have a pill box to organize days and nights. And since he will not eat any food I put the digestive enzymes in I put it in - I use it as capsule filler .

I don't know how I managed. I was able to work at home when he was first diagnosed as my husband had a bad accident so I was taking care of the two of them. And my DH was home in recovery since so once he was up and about he was able to help monitor. Wine and chocolate helps. And this board. They are here for more than helping with dosing. There is a wealth of knowledge and support. Don't forget to take time out for yourself. Wish I would of done that more.

 

My two kitties had either IBD or SCL, one likely migrated from IBD to SCL. Novel proteins don't help SCL. Keep a really good track record of what proteins you feed when, and when they either vomit or get loose poo or constipated. That's how I figured out what proteins worked and what doesn't. The company that Tracey got her allergy test from no longer exists. The other thing that can help is a good quality probiotic. The http://www.ibdkitties.net/supplements/probiotics/ website is a good one for describing what ones to give.

If your kitty doesn't like Cerenia, you might try getting some empty gelcaps to put it in. The #3, 4, 5 gelcaps all work for pilling cats. The larger the number the smaller the gelcap. I combined meds in a gel cap where I could, which allowed me to get a bunch of pills down in one shot.