Keep trying to regulate, or live with it?

Hi all!

It's been a while since I've been on this site so hi everybody!

Casey's fine, she's plugging right along, peeing, pooping, preening, and purring!

What she's NOT doing, is dropping her BG levels. We got to a point where her pre-shots are between 225-275, which is high, but that's on 7 units of Lantus and I just don't want to give her any more insulin than that (it doesn't seem to make a difference). I asked my vet if she could just be a high-sugar kitty and the vet said that was certainly possible, that some cats just don't get any lower no matter what you do.

She suggested that we could try another insulin, like Humulin, but I know that's harsher than Lantus and really, Casey seems pretty happy. She still has the neuropathy but I can't seem to get the better of that either - I tried Zobaline and gave her a ton of it, but I suspect that all the Methyl B-12 in the world won't make a difference if her blood glucose is high.

So...any suggestions? Aside from the suggestion to try Humulin, my vet seems to think we'd be OK to just leave things the way we are. I hate to give up, but on the other hand I feel like pumping Casey with more and more insulin isn't the answer either. Should I stick with things the way they are and just be satisfied that Casey seems like a happy kitty despite the neuropathy? Or is there something else that can be done that I haven't tried yet?

Thanks!

 

I have a few thoughts

1. The SS seems to end on June 2nd.. same kind of numbers since then? Whats her nadir normally? Be good to see an updated SS.
2. Do you test at PMPS+5 and on? spot checks? she may be dropping low then

To be honest though I am thinking acromegaly or something making her insulin resistant. Has she been tested? I know some cats go up to 10IU or beyond so I think i would keep going up and see what happens.. the breakthrough dose could be round the corner but without seeing an updated SS its hard to tell.

Wendy

 

if you visit the acromolegy forum, they list the tests you need to get done in order to determine if you have iaa, acromolegy, etc,. type cat.

i would check this out and get the tests done so that you know what you are dealing with.

I don't think changing to humulin is a good idea and I doubt anyone else will think it is a good idea too.

 

Hi Wendy!

I did curves for a while after I stopped charting, but when the numbers kept coming up the same I sort of fell out of the habit because it seemed pointless. I haven't done a curve in a while, I could do one on Saturday to see where she's at. It hasn't changed at all since June, though. I do still test before giving the shot, but as I said the numbers haven't changed at all.

I'll check out the acromegaly forum, although I seem to remember asking my vet about it last year and she didn't think Casey had it. The vet did do a fructosamine test on her, and it came back 400, which is within normal range.

 

There are 3 high dose conditions - acromegaly, Cushings, and IAA (insulin autoantibodies). They have different tests for ruling them in or out.

Given that the vet isn't seeing blatant signs of acromegaly (ex heavier bone deposits), you might start with the IAA testing first.

 

Hi! It's good to see you back again. I was wondering how Casey was doing. I'm glad she is a happy kitty.

Humulin isn't the only other option if you want to change insulin. Levemir has a very similar action to Lantus, but some kitties respond to one of them better than the other. A 400 fructosamine indicates excellent control, though getting lower would of course be better. Also remember that 225 could be really be 180 if your meter regularly reads high (meters are legally allowed a variance of 20%).

 

If you are feeding a good, low carb wet diet, and not giving any meds that can cause a need for a higher dose of insulin, it's likely time to think about testing for resistance.

Here are the 2 links you need to print and give to your vet:
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401 IGF-1 test
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1494 IAA test

I am not clear why you don't want to give your cat more insulin if she needs it.... your ss is not updated past June2012, so I can't comment on the numbers you are getting, BUT if you are still home testing and not getting numbers below mid 200s AND you are not using any of the FreeStyle meters with the butterfly strips, it's likely time to have the 2 tests done.

I can't say for sure about the B12, but please DO continue giving it for the neuropathy.
For your vet to say to leave things how they are is giving up. ..... What if her good dose is just a bit higher? It could be around 9u BID or 12u BID, so why stop at 7u?

If you want to try an insulin switch, avoid humulin; you will end up in the 400s and have a very sick cat.
Instead, you may want to switch to Levemir as you may end up with the same dose but better BG numbers.

If you do have some recent numbers, maybe you can start up your ss again and it will help people to give you some better feedback.

The reason you may want to have the tests done is to let you know what's going on. If Casey does have acro or iaa, then she has a fully functional, healthy pancreas. What that means is that she may well go off insulin!
If she has only IAA, it's a temporary condition and if you are more aggressive with the dose, you could well defeat the antibodies and Casey would end up OTJ.
If she has acromegaly, she can also go off insulin, and I know this first hand because my own cat, Oliver, went OTJ last January, and his highest dose was up to 37u BID Levemir. I know of another cat who was on insulin for just a few months, was tested positive for acromegaly, but then he had a couple doses of 7u, and he just suddenly went off insulin. As far as I know, he's still off insulin.

If she is positive for acro and IAA, it's still possible to go OTJ because my Oliver tested positive for both.

Please don't write off Casey as just being OK. There are health issues that may come along with acromegaly including organ growth, soft tissue growth, so knowing is important.

Continue as you have been with dosing, following the protocol as you have been. You want to get nadirs down into the 100s, so if this dose is not getting Casey there, hold for the usual length of 6 cycles, then increase by .5u.

There are plenty of people here who can help you with support and info, so don't give up on Casey.

 

Hi Blue and everybody! Thanks for your thoughts!

I guess I stopped at 7 because going up didn't seem to be doing any good - Casey was giving me the same numbers at 7 that she was giving me at 4, and I didn't want to give her any health problems by giving her too much insulin.

OK, here's what I think I'm going to do. Unfortunately, I don't have the money right now to take Casey to vet for tests, but I'll have the money in a couple of weeks.

In the meantime,I'll edge her dosage up and do a curve on Saturday and see where we're at. I'll post the numbers to her chart. I'll keep posting the numbers and when I have the $$$, I'll take Casey to the vet and get the tests done. Then we'll go from there.

My vet did give me injectable B12 to give Casey, but it's not methyl-B12, it's just regular B-12. Is it going to do any good? Does anybody know?

 

It appears you have: Cyanocobalamin is the most common and widely produced of the chemical compounds that have vitamin activity as vitamin B12. Vitamin B12 is the "generic descriptor" name for any of such vitamers of vitamin B12. Because the body can convert cyanocobalamin to any one of the active vitamin B12 compounds, by definition this makes cyanocobalamin itself a form (or vitamer) of B12, albeit a largely artificial one.

I give four of my cats weekly injections of Cyanocobalamin

 

I think it has to be the methyl form at least for neuropathy ie http://www.laurieulrich.com/jasper/

We usually increase dose based on this to ensure we dont skip past a good dose...

 

Yep, what I have is Cyanocobalamin. I gave it to Casey for a while, but when it didn't look like it was doing anything I stopped, because I figured that if her levels weren't lower, it wasn't going to help anyway. So maybe I should start giving it to her again?

 

I would give the shots of B12 weekly; Casey will benefit from the shots.
I gave shots to both of my cats, and one improved a great deal with her inflammation due to pancreatitis issues.
Many people give their cats weekly B12 shots just as maint.

Keep increasing the insulin dose following the protocol, letting each dose settle. You WILL reach the dose that will bring Casey's BG numbers down to a decent level; you just have to keep climbing up till you reach it.

Think of a very cold room.... you want the temp to be warmer. You can turn up the heat by 1degree and wait a bit. If it's still not warm enough, turn it up 1 more degree. Now, if you turned it up by 7 degrees but it was still cold, would you stop? Surely, you would not say Oh well, I went up 7 degrees and it's still chilly, and since that's a big increase, I guess I'll just stop.
You would want to continue, upping by 1 degree and waiting a bit, repeating until you got to a good temperature, yes?

That's what you should do, for now. Keep upping the dose by .5u increases, and testing to be sure you know when you are getting close to the good dose, then you can slow to .25u increases. The resistance tests are good to have done, but they are not mandatory to do quickly because what will change? Not much. You will know the reason why you need a higher dose than others, and will be able to learn precautions, but you will still treat the same: you will continue to give enough insulin to get BG numbers in a good range.

 

Just an update: I took Casey to the vet today, she threw up yesterday and this morning got three legs into the litterbox and peed all over the floor.

The vet ran tests and found out she has a urinary tract infection. The vet thinks she might be hyperthyroid, and also maybe have high blood pressure. Her heart's also enlarged a little bit.

She's on antibiotics now, and once everything is back to normal we're going to talk about doing tests, etc.

Just wanted to let you all know! Further bulletins as events warrant.

 

Ok good - a UTI could be keeping her BG high!

BTW I saw you updated her SS.. thanks! Do you have data from today or last night? Would really like to see how she is doing generally. Although once the antibiotics kick in that could all change!

 

Heart issues are pretty common with acromegalic cats, so you want to take care if you were to need to give Casey fluids.

 

I haven't had a chance to update her spreadsheet, but this morning her preshot was 338. Tonight her preshot was 341 - both pretty high numbers, but I'm guessing it's the UTI talking. Casey was dehydrated in addition to everything else, so once the fluids soak in and stuff the numbers should come down.

I increased her insulin to 7.5u, and I'll hold it there until the infection clears up and see where we're at. Thanks for the help, everybody!

ETA The vet did do bloodwork, and everything looked good except her potassium is low (which we'll address once the UTI clears up). She also took X rays to rule out bone problems and tumors, and said she didn't feel anything in Casey's belly that would signify a problem.

 

Could be, but she also could be bouncing from a low overnight or could be dropping down during the day... Do you do spot checks?

 

If you are giving fluids yourself at home, a large amount is hard on the heart, so it will be easier on Casey if you split the amount.

 

Yes, for neuropathy it has to be methyl cobalamin (methyl B12). It's sold as 'Zobaline'. And some people here buy methyl B12 in capsules instead. Despite high BG numbers it can still have a dramatic effect on healing neuropathy.

 

High dose conditions aren't generally considered until the cat is over 10u a day, so there could still be something else going on.

This was my thought as well. Your previous data had no real testing done at all after the PMS. She could be dropping much lower at night than during the day, so you could have bypassed a good dose in the beginning and now she's experiencing what is known as a high, flat curve from chronic overdose. From here (emphasis mine):

ETA: Forgot to mention, I also agree with the other posters to rule out (or in) any high-dose conditions. This is just something else to consider.


___________________________________________
A Note on Somogyi Rebound: They are using the common definition of Somogyi Rebound, which is actually just a "bounce" when a cat goes from low numbers to high as the liver tries to compensate (glycogenolysis). The technical definition of Somogyi Rebound would be if if his numbers spiked over his "normal" high and there was the presence of certain hormones (glucagon, as well as the stress hormones epinephrine, cortisol, and growth hormone). For example, if the cat's range is generally 60 to 300 over the course of the day, then he drops to 39 and bounces back up to 280, that is NOT Somogyi Rebound by definition. If the cat drops to 39 then bounces back up to 330, that might be Somogyi Rebound only if there is the presence of the additional hormones and other factors have been ruled out (i.e. stress, insulin worn off, etc...). Currently, true Somogyi Rebound has yet to be scientifically proven to exist.

 

Once I got over 6u of Levemir I had my cat tested for IAA and Acro- she came in positive for acro- 400's but not for IAA.

And Humulin will do absolutely NOTHING for your cat and can actually harm her.

ETA*** If she is a high dose cat and her numbers continue to be in the high range for too long.

 

I just wanted to point out that Casey's not new here; the ss just stops in June, but the proper increases were done..... just not recorded on the ss.

Now, since over time, Casey's dose has slowly risen to 7u, they're back here and posting again.
There's no point in filling in the past 6 months of numbers as they were likely pretty similar to the old numbers on the ss.... the pattern in past numbers did not show any big drops during the day cycles, so I highly doubt that Casey's dropping low at nights. The 180 AMPS recently could very well be a late nadir; my Oliver quite often had nadirs around ps times.

Somogyi rebound on Lantus when the increases were done slowly is highly unlikely, so continuing with increases as usual will get Casey to her good dose eventually. Getting from 4u BID to 7u BID in 6 months is plenty slow enough... the proper dose was not passed. Finally, the curves are not high and flat with sudden drops, so I think Somogyi's about ruled out here.

Once there are some recent BG numbers on Casey's ss for this dose, a better picture will be seen.

 

Hi everybody,

Thanks for the fill-in, Blue! You're pretty much dead-on. I don't even have the past six-month's numbers to fill in, but rest assured that I went "low and slow" with Casey, and only stopped at 7 because I was nervous about giving her too much insulin (especially when upping her dose didn't result in any change at all).

Unfortunately the UTI is sort of messing up getting a bead on what her proper dose should be - she basically stopped eating, and her BG dropped. I've got her on antibiotics and I'm calling the vet before each dose for the time being, to tell her how much Casey is eating. The vet gave me some CliniCare liquid diet to give Casey to get some nutrition in her, and I'm mixing it with Fancy Feast pates and she's eating that. I'm hoping that by tomorrow or the day after Casey's appetite is back to normal. I have to give her the antibiotics for about the next three weeks, so I and the vet will probably take a look at what to do about Casey's BG after that time, when her BG numbers are more "regular".

I'll keep y'all updated! I'll also be updating the spreadsheet as time permits.

 

The regulating issues will have to sit on the back burner while you get the UTI cleared up.... you can increase slowly while the AB are getting the infection cleared and as you test, you'll see the BG lower as the UTI gets resolved IF you are at a good dose for your healthy Casey. If she does need a higher dose, you will just see the same numbers but a perkier healthy Casey.

Quite often, when Shadoe had issues with pancreatitis, her BG would go up and I'd just dose her with what she needed to get the best numbers, regardless of health. As she got better, her dose needs dropped.

Since you are already great at testing when needed, and knowing signs with your cat, let Casey's numbers decide what to do.... no need to do any big, fast increases, but also no need to hold the dose in hopes the meds with make everything better and make the current dose be the right dose.
With resistance, you get used to seeing more fluctuation in numbers and dose needs compared to the usual DM cat at a much lower dose.

Fingers crossed for a quick improvement in the UTI.

 

Thanks, Blue. I appreciate the advice!

Interestingly, Casey's appetite seems to be returning, but very selectively. She LOVES the CliniCare the vet gave me. Will eat some Fancy Feast paté, and also scarfed down some cooked chicken I put down for her while I was making lunch. Isn't interested in her usual 9 Lives paté.

Oh, well, that's cats! She does seem perkier than she was before I took her in, so I'm hoping the trend continues!

On a side note: I paid for this visit with a new credit card I got called Care Credit. It's a card used primarily for health care, like dental offices, but you can use it at participating vets' offices too! Came in darned handy, I'll tell you what. Purchases are no interest for 6 months, which is a help. Just FYI!

 

Great news that she is being more catty and selective with foods.... whatever you do, don't go out and buy a box of some food she likes today because tomorrow, she may want her 9Lives back again!
So long as she is eating, that's the main thing.

I have heard of the Care Credit from others; it sounds like a very handy card to have because you never know what's needed at a moment's notice for our cats.

 

Thanks, Blue. This does help clear up the picture. Sorry, Casey's mom!

I've never heard of this before, but it definitely sounds like something I could use! Mikey got diagnosed faster than I could get the pet insurance for him, so now, with his "pre-existing condition," the pet insurance is worthless. :?

 

Hi folks!

Casey's appetite is back, so the antibiotics seem to be working, yay!

Here's a question: I've been giving Casey 5us, and her BGs were 218 this morning, and 262 tonight. Since those were pretty much the numbers I got when she was on 7.5u, is there any reason for me to go back up to 7.5u? As long as her numbers don't go higher, I mean. Any thoughts?

 

The answer is are you at numbers that are non-diabetic? if no, then up the dose.
you will still follow the same protocol as before....

"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.


the 200s fit into the .25u increase....

There is no rule that says untreated cats will always be in the 300s and 400s or higher, right?
Who's to say that YOUR cat's untreated numbers are mid 200s.... remember that if your cat is acro, there is nothing wrong with the pancreas and the cat's organs may was just be working overtime, but not doing that well.

Keep your eye on your goal: you want to be able to get your cat's BG into a nice non-diabetic range. Ideally, everyone wants their cat to be in green numbers, or most certainly, the 100s.
You are not there yet, so up you go.

You can take your time, following the protocol by holding for 6 cycles, and upping by the .25u if you have nadirs all in the 200s.

My Shadoe was at 14u and then she had a dental. Her dose dropped down to 2.75u, but by following the protocol, I upped the dose as fitting. She had already tested positive for acro, so I knew the dose would rise, but I still followed the rules.

 

I'm so glad to hear that Casey is eating again! I think you need a mid cycle test to see how low she is going before you up her insulin.

 

Oh, yeah, she's eating! I came home from work tonight to find out she'd eaten all the DM Critical Care soft food I'd left out (about half a can), nearly all the FF I put out, in case she wanted to eat her regular food (3/4 can) AND all of Kennedy's FF! (probably about an entire can). I'd say her appetite's back! I'll get a mid-cycle as soon as I can, to see where she's at.

 

Well, I thought we were out of the woods, but after 2 days of Casey's appetite coming back and her BGS being close to 'normal', this morning I woke up to find that she'd thrown up all the carpet (just brown liquid, no food) and wouldn't eat anything - not the CliniCare I put out, or milk, or regular food, or anything. :-(

Her BG was 353. I called the vet and she said to give Casey a half-dose (3.25u) so I did. I pulled up all the dry food in the hopes that it's just that her tummy doesn't like it for some reason (it's Evo Innova Turkey and Chicken), and I'm going to stop by the vet's after work to pick up more of the ultra-bland, ultra-expensive Critical Care DM that Casey seems to like. I hope I can get the throwing up thing figured out soon!

Is there a cheaper alternative to the Critical Care DM wet cat food? It's ground really fine and Casey seems to love it, but I just can't afford to feed her food that costs almost $2 a can. Unless I have to of course, then she gets the DM and I'll eat Mac and Cheese.

 

I'm assuming you've seen the selection from catinfo.org? I've been basically going down the entire list and trying out anything under 5% carbs (my diabetic is highly sensitive to carbs) to see which my cats like best in comparison to price. :lol:

One I can think of off the top of my head is Friskies Special Diet. That's a favorite in my house. It is definitely more "ground up" than FF and Evo, but having never seen Purina DM, I can't say for sure. IIRC, I think the Merrick's BG (Before Grain) 96% is also really finely ground, although my cat hated it so I haven't bought it in a few weeks.

Another trick for foods my cats don't like but I don't want to waste is I sprinkle Parmesan cheese on top to entice them to eat it anyway.

I hope Casey feels better soon! :YMHUG:

 

Well, Casey is back at the vet's again. She didn't anything last night either and threw up again, but this time there wasn't any color to it because she didn't have anything in her stomach. I took her BG and it was a whopping 554 - not sure the read was totally accurate because got an 'error' message right after the reading, but in any case the vet told me not to give her any insulin, that they would do it there.

She wouldn't eat ANYTHING this morning - and I set out practically everything I had in the fridge hoping something would appeal to her. It's weird because she acts hungry - runs to the fridge - but when I put the food down she sniffs at it but doesn't eat. Maybe she has a nasal tumor or something? I've heard cats won't eat if they can't smell what they're eating...

Anyway, she's at the vet's all day so they can see if they can figure out what's going on. I'll keep you all updated!

 

prayers and white light that all is something simple to take care of.
hugs to you

 

Oh, no! I hope Casey is better soon.

 

{{Hugs}} I hope they can quickly figure out what's going on with Casey and she starts eating again.

 

OK, I'm back from the vet.

They couldn't find anything obviously wrong with Casey, although they said her urine is looking a lot better. X-rays didn't show anything, the vet couldn't feel any masses, and didn't see any signs of a nasal tumor. She didn't have an answer as to why Casey decided to stop eating and start throwing up - although she mentioned she could have a slow-growing tumor in her intestines, but the only way to make sure is to do exploration. They gave her insulin and fluids.

The vet gave me some anti-nausea pills and another bag of fluids for Casey if she still isn't eating, so she doesn't get dehydrated.

In a way I'm relieved that nothing's obviously wrong like cancer, but on the other hand I'm frustrated because nothing's obviously wrong so I don't know how to fix it! I guess I'll just hang in there and see how she's doing over the weekend. I'll keep everybody updated!

 

Throwing up and not eating and high BG.... did the vet say anything about bowels, and did the vet test for pancreatitis?
What insulin did the vet give and how much and when? You need to make a note of all you can on your ss.
What was the logic behind mentioning tumors in nasal and intestines? And exploration as in something invasive? I don't understand resorting to such major and dangerous actions.

I would not say nothing's wrong because you would not see a stop in eating, vomit, and high BG.
Were the bowels clear, no blockage at all? Was blood done for testing and was fPLI test included? What about testing urine, c&s would take awhile but could clear up any infections in that area.

When a cat's sick, has high BG, and not eating, you don't want to be holding back on the insulin. The recipe for DKA is infection, not enough insulin, not enough food. Please see if you can test for ketones as well till you are seeing some improvement.

 

Ketones were negative. I forgot to mention that earlier, sorry.

Bowels were clear. Vet gave 3.5u of Lantus at 9 a.m. I'll call tomorrow morning and ask about the pancreatitis. They tested the blood last week when I took her in, didn't find anything unusual. What does c&s and fPLi stand for?

The nasal tumor was my thought, not the vet's. She only mentioned the growth as something that would possibly cause problems, but wouldn't be obvious right away.

 

Good to hear about no ketones; it's a worry when you drop insulin and not eating, and you don't need high BG for ketones.

You did mention lactulose and miralax earlier on the ss. If you have been having bowel issues, some constipation, vomiting can be a big sign of a possible blockage.

I know of one cat who's just had a blockage removed at the vet and once the hard portion was removed he did vomit before passing the 'backlog'. He had also been vomiting in the couple days prior to the vet visit.

My Oliver has megacolon and we are waiting for some output; he has vomited a couple times in the last 24hrs and now has some diarrhea which can be seen just prior to the real backlog to be output.

Are you still adding the miralax to the food, and are you seeing regular bowel movements?

 

Yes and yes. She had a bowel movement yesterday, but it wasn't much since she hasn't eaten much.

Thanks for your help.

 

So should I give Casey the whole 7.5u even if she hasn't eaten anything?

ETA It's 9:30, I just tested Casey's BG and it's 224. I'm going to give her 3.5u since she still hasn't eaten much of anything. Her stomach is gurgling, though, really loud! Anyone know what that means?

 

You asked about c&s.... culture and sensitivity testing of urine.
http://www.felinecrf.com/tests0.htm

With older insulins, it was said to hold insulin if the cat's not eating, but with Lantus, you normally test and shoot to an empty stomach.

What foods were being eaten before, and how suddenly did the eating stop?
Ask the vet about trying an appetite stimulant if you have tried all foods and absolutely nothing is being eaten.

Could it be nausea? Is any food at all being eaten?

 

Casey was on a diet of the 9-Lives low carb wet food. The eating stopped very suddenly. The vet gave me the Hills AD and DM, and Casey was eating the AD, but then that stopped too.

This morning she ate a few bites of cooked chicken and a few sips of milk, and that's it. Her BG was 272. I went ahead and gave her 7.5u.

I'll call the vet and ask about an appetite stimulant. She gave me some anti-nausea pills to give Casey, we'll see if those do anything.

Should I give her Pepcid for the stomach gurgling?

Is it possible Casey's just 'shutting down'? I'm really baffled here.

 

What did the vet say about pancreatitis?

Could it be a fur ball? Is she prone to that? If she is trying to clear it she may be vomiting a lot and not hungry. You could try a dab of vaseline on her paw (she will lick it)

Here are some suggestions on getting her to eat.

 

Thanks for the suggestions, Wendy! I finally talked to the vet, it turned out they did NOT test for pancreatitis! I'm taking her in Monday so they can get some blood and do that.

In the meantime, the vet gave me some appetite stimulant tablets and I went to the store and got some parmesan cheese and baby food. I mixed the two together and Casey took a few bites of it, we'll see what happens! The vet I talked to (different from the one I took Casey to last week) sounded surprised that they didn't test for pancreatitis, but that Casey didn't have any CRF.

Onward and upward! I'll keep you all posted. Thanks for all the support!

 

Is Casey still on antibiotics? If so, that can cause a vomiting problem too. The last two times I gave Clavamox, my cat vomited within the first two days. As soon as I stopped, she didn't vomit (and she is not prone to vomiting by any means). Next time, I'll have to request Baytril or something else.

You can read about the specific fPL test here: http://www.idexx.com/view/xhtml/en_...menu/innovative-tests/spec-fpl.jsf?SSOTOKEN=0. Basically, it is a blood test that provides the amount of pancreatic lipase in the cat's blood versus the usual serum lipase.

A good general article on Pancreatitis itself and what to do about it is here: http://www.idexx.com/pubwebresource...pec-fpl-treatment-for-feline-pancreatitis.pdf

My vet totally missed it in my cat too, because she didn't seem to be in any pain and was not vomiting, off food, etc. However, it was someone in the CKD group that noticed her labs indicated the possibility. So, my vet finally agreed, at my nagging, to do the fPL. It came back 27 twice (2 weeks apart) (>= 5.4 means very likely). Then I had an ultrasound done and discovered her pancreas was toast. It was important for me to know this, because now I am under no delusions that Sarah will ever get off the juice. If somehow it happens, awesome, but it probably won’t. So, now we know that it is her pancreas that is causing the diabetes.

Since my kitty has CKD, she has been on sub-q's for 15 months now. When the pancreatitis kicks in, she might be less worse off because she is already getting fluids. They are extremely helpful for many issues. My cat also has a heart murmur, and she has not been affected by the fluids. However, of course, I don't overdue it in one sitting. So, if your kitty can handle it, and your vet recommends fluids, please do try, because they probably will help Casey feel much better.

DZ and Sarah

 

Hi DZ and Sarah!

Yes, I still have Casey on the antibiotics, but she was throwing up before that, so I don't think they're the cause. Casey's got a heart murmur too, and a slightly enlarged heart. I'm supposed to give her 100mls per sitting. I'll probably try the first one tonight or tomorrow. Wish me luck!

BTW, she just ate some chicken & broth baby food with parmesan cheese mixed in. I'm hoping this starts a trend...

 

Good to hear about the eating!

Let me know if you need any info. on giving fluids.

DZ and Sarah

 

Casey update!

Her appetite seems a little up this morning. She wasn't interested in any of the cat food I set down, even with parmesan on it, but gobbled up some pieces of cooked chicken, so I guess that's a start! Her BG was 252. How does the appetite stimulant work? Is she going to become ravenously hungry, or is it just a slight boost? At least she's eating *something*, even though I know cooked meat isn't as good for cats as raw...

Would you guys recommend that I give her some Miralax? On the one hand I don't want her to become constipated, but on the other, since Miralax works by drawing water into the intestine I'm afraid it'll make her more dehydrated. Thoughts?

ETA: OK, right now she's sitting in meatloaf position next to her water bowl, with her head actually hovering over the bowl. What could this mean? I know it's a symptom of Feline panleukopenia, but she doesn't match the obvious symptoms (eg, bloody diarrhea). ???

 

Hanging over a water bowl is a sign of a thirsty animal. Thirst will turn up in many symptom lists, including feline diabetes.
Meatloafing to me is often pain. Oh, not always, but when my Shadoe was having a pancreatitis attack which is painful, she was a meatloafer.

The appy stim I was giving to Oliver when he was very sick was to be given every 3 days.
Shortly after the pill was given, he wanted to eat, ate well, and with apparent appetite. He ate like normal on the first day, then ate a bit less the 2nd day, and by the time for the next dose, he had not been eating much. I gave him another pill and within hours, everything repeated.... his interest in food returned, and he ate.
I don't know about any mechanisms, but to me, it made him eat and I was happy.

With miralax, you need to add water to his food. If she won't eat souped food or is eating only chicken, then just mix the miralax into some water and syringe it into the corner of his mouth.
You do NOT want constipation, stretched colon, or megacolon.

Just curious but why are you suspecting feline panleukopenia?

 

I'm a complete newbie to this forum, my sweet girl just got diagnosed and I haven't even started insulin yet. However I'm so impressed with your commitment and love for
your cat. I hope casey gets better soon, will be following!

 

Lesley,
You have found yourself a good site, and I am glad you are posting before starting insulin because often some changes can be made to a cat's diet, and health, and there's a possibility of no need for insulin.

I wish you well with your girl. There are many knowledgeable people here who can help you.

 

Lesley,
You have found yourself a good site, and I am glad you are posting before starting insulin because often some changes can be made to a cat's diet, and health, and there's a possibility of no need for insulin.

I wish you well with your girl. There are many knowledgeable people here who can help you.Blue

Thank you Blue!! So impressed by the wealth of knowledge here. My Molly is a lucky girl to have this resource. Ohiogal, I will be pulling hard for you!!

 

Oh, just because of the water bowl thing. Shortly after I posted she got up and moved anyway, so it turned out to be temporary!

Her appetite still hasn't really come back. The vet instructed me to give her 1/4 pill every couple of days, but that doesn't sound like much...I gave her 1/4 pill yesterday, should I give her another 1/4?

Also, I began giving her fluids yesterday, but only got 50ml in before she became restless and I had to take the needle out before she bolted and hurt herself. I got 50ml in today, but should I give her another 100ml or hold off till tomorrow?

Thanks for all the help, I really appreciate it!

PS Hi Lesley! Welcome to the forum.

 

Follow the vet's instructions on the 1/4 pill. Cats are much smaller than us and drugs may work differently in them vs humans.

 

Just got a call from the vet - yep, it's pancreatitis.

They're going to keep her overnight to get some fluids and antibiotics in here, and we'll go from there. The vet seemed pretty confident that Casey will bounce back from this. The important thing is to get her eating and not throwing up.

Further bulletins as events warrant! Thanks for all the positive vibes and advice. I probably never would have thought to ask about the pancreatitis test if it wasn't for you guys!

 

Great! FInally we have a diagnosis and can move forward ! It must be a relief to know whats going on at last!

 

I'm so glad you have a diagnosis. It's hard to get results when you just treat the symptoms without knowing what is causing them. Casey should be feeling better soon!

 

She is! I just got a call from the vet, Casey's started eating again and they're getting fluids and other meds into her. I should be able to bring her home tomorrow afternoon. Huzzah!

Apparently pancreatitis isn't something they test for routinely when they have a sick kitty; it's something they actively have to be looking for. I sure am glad you guys are around, or else I'd still be sitting here feeding Casey appetite stimulants and wondering why they aren't working!! You guys are AWESOME! {{{hugs board}}}}

 

Yay! So they are keeping her tonite?

 

Yes. They wanted to keep putting the fluids and meds in her, and monitor her progress through tomorrow to make sure things keep improving. So far so good! Apparently she's already eaten an entire bowl of food.

 

What pain meds will you get to bring home? Get bupe because pancreatitis is VERY painful.
The fluids are something you can give yourself at home..... with pancreatitis, you should really give them for a few days. You will see an improvement in BG numbers. You can give 1/4 tab of pepcid AC 10mg BID; it will help with upset stomach. I am not sure why the need for AB; the problem is inflammation.... maybe you can ask if there is also an infection.

Did the vet tell you the result number? If not, it would be good to ask. Both of my cats had issues, but Shadoe had much higher numbers and more difficulties and pains, while Oliver had numbers that were mildly raised, in the grey area. I found that weekly B12 shots did alot to help Shadoe and she seldom needed the pepcid after needing it BID for months.

 

Yeah, so happy for you and Casey!!!

 

Sorry, Blue, I'm obtuse - what's AB and bupe? I'm not up on the lingo...maybe you should use the whole word instead of the abbreviations around me!

ETA: OK, I think I figured out one of them anyway - is AB antibiotics? She's still on antibiotics because her white blood cell count is still way up.

 

AB = antibiotics
Bup = buprenorphine

 

Casey's home! She's running around and meowing for attention, much more active than she has been! The vet gave me 'bupe' for pain control. Casey looks a lot better, and I'm encouraged to think that she's going to be OK. Her BG was 199 this morning and she's been eating much better.

I'll keep everybody updated. Thanks for the positive vibes!

 

I just gave Casey her Buprinex, the vet gave it to me in syringes that I can just put into her mouth and squeeze to get the dose in.

Problem is, when I tried to get it into Casey's cheek, she jerked as I depressed the plunger and it went into her mouth instead.

Is that bad? I don't think I should dose her again, but I think she swallowed it instead of it going into her cheek.

How the heck do you do this? What cat is going to sit still while you inject something into their cheek pocket? And, don't they end up swallowing it anyway?? Can someone clue me in? Thanks!

 

I think they want it absorbed through the mucus membrane a bit hence the cheek pocket. Maybe try again tomorrow.

Also now that she is getting better and once she is eating better we should discuss next steps for controlling the diabetes. Can we get you on the tight regulation protocol now?
let me know
Wendy

 

I'd like to make sure Casey is past this first. The vet wants to see her next week for a follow-up. I just took her BG and it was 232, so per the vet's instructions I gave her 5us. I'm going to watch to see how much she eats overnight and tomorrow. She also needs to regain some weight. She's down to 9.5 lbs, and she was 12 lbs last June.

 

Keep testing her, even five units could be too much now.

 

OK, I will. Her BG this morning was 292 (she'd already eaten, though, so that might have driven the number up), and she's eating like a champ. Yay! I'll keep giving her 5us and then do a curve over the weekend and see where we're at. She's already pooped twice since she got home, so it looks like the plumbing is in working order!

 

[OK, I will. Her BG this morning was 292 (she'd already eaten, though, so that might have driven the number up), and she's eating like a champ. Yay! I'll keep giving her 5us and then do a curve over the weekend and see where we're at. She's already pooped twice since she got home, so it looks like the plumbing is in working order![/quote]
Yeah!!!! :RAHCAT

 

What great news!!! Give that cutie pie a scratch behind her ears from me!

 

I sure will! :smile: I still have to get the hang of giving her the Buprinex, though. Trying to get her to hold still long enough for me to get anything into her cheek is tough! She chewed on the syringe just as I was injecting this morning, and it went into her mouth again. If anybody has any tips, I'm all ears! I don't want her to be in pain, and this is the stuff that's supposed to help with that...

 

Another reason for squirting the bupe into the cheek is so you don't get any in the lungs from aspiration.
In the cheek, it can be swallowed safely.

 

The bupe will work fine orally..... some people give buprenex injections as well, but I am sure you will see a happier Casey with the oral. Just aiming for along the side of the throat is good, and holding the head loosely but securely will help you get the bupe closer to the cheek pocket. It sure isn't easy to give anything orally, and the first time for squirting in the mouth, with bupe, maybe was surprising to Casey.

The AB is great.... it sounds like you have a couple problems going on - did the vet say when you need to come back to see if the WBC is better?

Testing as usual is important now because pancreatitis will have a tendency to raise BG somewhat, but you can't count on it to be the cause of that much of a dose increase.

Now that you have the pancreatitis dx, be on the lookout for the signs again as many cats have recurring issues. Not eating and sitting in a meatloaf position are pretty classic outward signs, and if you start to have eating issues again, you can give 1/4 tab pepcid BID and it will help to settle the stomach enough to get a cat to eat again. I used to give Shadoe her pepcid first thing in the morn, before shot and food, so that she would be settled.... mornings were worse because she had not eaten much overnight.

You can add extra water to the food as well and it will help like giving fluids... should Casey start acting 'off' again, you could talk to the vet about having fluids to give at home.... it's cheaper for you and kinder on Casey to get treated and not have to be bundled up and taken to the vet when sick.

You are right to put aside any sort of regulation until you have the pancreatitis issues cleared and a confirmation that the AB have cleared up whatever was giving Casey the lousy WBC. Acting better right after coming home is a good sign, but it's a common one after getting fluids and then some bupe to knock out the pain. It'll take a few days, so wait until all the AB have been taken and then see where Casey is.

 

Thanks, Blue! And thanks everybody, for the support! I'm taking Casey back later next week for a follow-up.

Casey is still doing pretty well, she's eating really well (cleaned her plate last night!). Blue, what food should I be giving her for the pancreatitis? Of course the vet says DM is the best, but I'm skeptical about that. Right now she eats the 9 Lives patés (like Super Supper, Tuna in Sauce, Turkey and Giblets, etc.)

 

Casey update!

Everything is going very well. She's eating like a race horse, gaining some weight back, and doesn't seem to be in any pain or anything.

What's really freaky is that Casey's BG numbers have gone down dramatically in the past two days - yesterday her AM was 157, and today it was 111! What's up with that? She's eating fine, doesn't seem to be having any trouble, so now I'm wondering why her numbers are going down? Anyone have any ideas? Is this another problem, or is it a Super Bowl Day miracle??? I updated her spread sheet if anyone would like to take a look. Thanks!

 

Maybe because the pancreatitis is improving? Keep a close eye on her nadir - her insulin dose might need to be brought down.

Do you want to start posting on Lantus TR now? http://felinediabetes.com/FDMB/viewforum.php?f=9

 

That could be it I suppose, but I didn't think the pancreatitis improving would cause her numbers to be lower than they've been since I started taking her BG last year. Is that usual? I just figured they'd go back to the levels they were before she got it.

I'll start with the Lantus stuff after I take her to the vet for the followup. Thanks!

 

maybe she had a wonky pancreas for a while? Can you do a + 5 , +6 or +7 today? Would like to see how low she is dropping...

 

I couldn't do any of those today because I was at work, but her +9 was 198. And boy, was she hungry when I got home! I put down her snack and she ate it like she hadn't seen food in a week!

I'd like to know what her nadir is right now too, and also what her AM is tomorrow morning. Stay tuned, I guess!

ETA Her AM BG was 147. I gave her 4u.