? Needing guidance and reassurance

I have so many questions and worries, but I'll try not to ramble.
My boy has been on Lantus for a relatively short time, but numbers are pretty high. Just upped the dosage. Vet said to go to 2 units from 1.5, but I was a bit scared because I couldn't be around as much this week to monitor, so I'm easing in. Initially, after the dose increase we finally saw a couple of readings in the 200's which made me so happy, but I think a secret bounce may have happened at a time i wasn't around to take a reading.

BUT, he's got serious pancreatitis and a wound that developed after the tech at the vet nicked him while trying to get blood from him. He then licked it to death, we went in for treatment, and there was a mis-step by another tech treating the wound and...it got WORSE. Apparently, diabetics have troubled skin and problems healing. Also, he received a CONVENIA shot, which made him instantly lethargic, he seemed to forget where the litter box is, and, for the first time, he's mostly inappetent. I can get him to eat little bits, but that's a real chore. Not the normal boy. I read about the controversy surrounding the shot, of course, once I began looking up whether lethargy could be a side effect of the antibiotic, and now I'm racked with remorse, but I'm trying to do all I can to battle the side effects, and to battle my worry (not working),hoping that some larger issue hasn't developed as a result.
Sadly, the day I took him in to get treatment for the skin thing and they gave the shot was the first day his numbers seemed to be changing for the better, which was about 9 days ago. Since then, we're in a fight to get things right.

Trips to the vet for bandage changes and evaluations every other day, plus the soft cone he's got to wear some of the time do not help with his stress level. All of this to say, his numbers are really hard to drive down.
He's fed up and seems like he's given up.

The vet gave me PERIACTIN for his appetite, but he's SO knocked out when I give him that that it's hard to tell what's happening with him, plus it makes me sick to see him so knackered. Do people have good luck with this despite the grogginess. Am I just being a worrier?

As for caring for his pancreatitis, I only have subQ which he's not always amenable to, and Pana Care which makes it so he REALLY won't touch his food. So that's out.

I really feel like I'm in the wind with my treatment and I'm just so so sad about the sudden turn in William's health. Before, his numbers were ugly, but he was still himself and we just had to work with the insulin and get that sorted. Then that shot and everything became really ugly. I'm trying everything I can and I feel like we just keep having set backs and we're both so exhausted.

 

Squeaker has pancreatitis every 6 months to varying degrees. His last bout was 3 weeks ago and fairly serious with explosive diarrhea and vomiting. So I'll give you my experience with that first.

Was a Spec fPLI done to determine that it is pancreatitis? I ask as I wonder how the diagnosis was determined. If William does have pancreatitis he needs something for nausea, Cerenia. Nausea could be part of the reason he is not eating. I also notice that you are feeding Purina DM, in my experience this is also part of the problem. Squeaker refused to eat it after a few days; not even the local strays would eat it. The standard treatment for pancreatitis is nausea and anti acid meds, pain meds, and fluid therapy. I've never heard of/used Pana Care and am uncertain what the benefit is to be. It is imperative that William receive the sub-q as there is a danger of dehydration with pancreatitis and that is compounded by the diabetes. This pdf will explain the necessary treatments for pancreatitis http://www.idexx.es/pdf/es_es/small...pec-fpl-treatment-for-feline-pancreatitis.pdf

As far as food/appetite. It is imperative that William eats now. This in addition to the diabetes and pancreatitis may be why you are seeing an increase in BG. Anything you can get him to eat now will be helpful. A good thing to try is baby food chicken to get him eating. Make sure it has no onion or garlic. I use Beech Nut, it contains only chicken and chicken broth. It is not a nutritionally complete food so should only be used short term and especially in cases like this when there is a loss of appetite. Additionally if you have to resort to assist feeding the baby food is much easier to push through a syringe. Other things you can try to entice William to eat is to sprinkle grated parmesan cheese on top of his food, sprinkle with FortiFlora (available from your vet), or use the water from a can of tuna in water (not oil). I have used all of these "enhancers" at one time or another and they work for us.

I would not continue to use the Periactin or the Pana Care. Experience speaking here, the larger part of the appetite issue is nausea, stomach acid, possibly pain, and the food choice. Many with diabetic cats (me included) feed food that is under 10% carbs. Great alternatives are Fancy Feast Classic and Little Friskies Classic Pate ( with the exception of Mixed Grill flavor). They are low carb which is what diabetic cats need, lower cost, and best of all cats will reliably eat them. Another benefit is by feeding low carb food is that alone can help to reduce the glucose level. Here is a food chart for your reference. Please look it over and find a food more appealing for William than Purina DM. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

If you need suggestions on how to give William sub-q fluids don't hesitate to ask. I have developed a number of strategies that I use with Squeaker. I would be happy to share that with you.

Please keep us posted on William's progress.

 

I will add to look at this primer on pancreatitis
created by @Marje and Gracie I would ask the vet for ondansetron for nausea, bupenorphine for pain, cyproheptadine for appy stimulant ...
and even if you have to feed a higher carb canned food for now.... it's important that he eat no matter what.

the cheapest place I can get bupenorphine is www.diamondbackdrugs.com where your vet faxes them a prescription and they call you for a payment method. I get 10mL for $41.

 

Thank you both so much for your responses. I must not have the email alert set up and was so sad when I thought no one answered me. But I was wrong!

William actually doesn't have any vomiting or diarrhea to go along with his pancreatitis, but I know that doesn't mean that his tummy doesn't feel bad and that he doesn't have pain. I have all of the things on the list, I think (picked up Cerenia yesterday to have on hand). I have buponex (i think that's the name) for pain (oral), but I'll keep that pharmacy in mind. Also, I believe Periactin is the brand name for cyproheptadine for appetite stimulant, which I do have.

He's actually teetering on doing a bit better after some real diligence on my part trying to present him with food and receiving fluids the other day- eating on his own, coming out from under things and peeking around the house. He got into bed for a cuddle which he hasn't done in a long, long time and he asked for food in the kitchen ( he'd been camped out in the bedroom, tucked into nooks and crannies). I gave him fluids again this evening. He's tough to get those into, but I know it's got to be done. I'm really trying to be equal parts nurse, non-scary loving mommy. It really guts me to see him like this. Tough.

We're going back to the vet tomorrow for her to look at the wounds that set off this whole spiral into extra sickness. I'm just hoping he doesn't backslide from the stress of it.

Thanks again. Glad to not be alone.

 

If he isn't eating enough to maintain his weight, you may need to syringe feed to help him out. Your vet can give you some large oral syringes, then you need to use a blender to puree the food with some water so it can go through the syringe easily There are some videos online of how to do it.