Oscar's Wonky Numbers - Possible Pancreatitis?

Posting this here to get more opinions about pancreatitis. Here's our latest history over the last 3 weeks:

Oscar's pancreas sure likes to keep us thinking, and I'll be darned if I can figure out what it is doing! Back around 4/10 we started to hit low dd's at +6 with 3.5u, so I slowly backed down the dose to 2.8u then started seeing a flat line curve wise. Slowly bumped it back up to 3u and got a +11 nadir in the mid to low greens, so slowly dropped it, and while dropping the dose we started seeing 17-20 hour durations even at 2u. So still need to drop it. Dropped to 1u and then to 0.8u and we didn't get past the mid 100s on nadir, ketones came back, and drinking/peeing increased. Ok, need to raise it a bit. Went to 1.2u - flat line. Raised to 1.4u two days ago with an amps of 254 and were at an inverse curve with a +6 of 319! What?!?!? He did it again the next day, but each evening we saw a mini curve. Today it looks like his body is beginning to stop fighting the insulin and we are at a 188 for pmps.

I need opinions as to what going on here. Is Oscar's liver protecting itself even though it really needs more insulin? He isn't wanting to eat the 6-7 cans of FF he was eating before all the greens happened, but he is still eating around 4 FF cans a day. I add water to his food each time. The trace ketones have to mean he isn't getting enough insulin. But his numbers are being very ambiguous.

We went to the vet today - his weight is holding steady from his measurement 3 weeks ago. Our vet has no idea why he seems to be doing well and then gives flat lines over and over again. His playful personality is back. He was peeing significantly less and eating a little less when we were hitting all the low dd's a few weeks ago. Bumping down the dose to 0.8 brought back the peeing and drinking full force, and now we are back to mid range hungry appetite and slightly large pee clumps. Our vet told us she is at the end of what she knows what to do and referred us to an internal medicine doctor in Indianapolis. Our current vet was worried about a possible recurring pancreatitis creating the flat and inverse curves we have seen randomly. This specialized vet is going to cost $125 for just the initial visit plus any tests they run :shock: Definitely can't go to them more than once, and even that is pushing it since we are without an income right now.

Cliffs notes - Oscar goes back and forth between dipping into the low dd's and not curving at all and our current vet is worried about possible random pancreatitis flare ups. No vomiting, pretty steady appetite, no weight loss, and has regained his former activity level.

 

no ideas?

 

Well, I refrained from commenting last night because you are using ProZinc and most of us are not familiar with its action because it's so new. *Assuming* it's fairly close in action to the other PZI's, there may simply be too many dose changes in too short of period of time for you to definitely know how it's working.

Has he been tested for infections? There are other factors involved in ketones besides not enough insulin, infection & food intake. Also, how are his kidney numbers, BUN and creatinine? Increased thirst is also a symptom in other diseases, such as kidney insufficiency and hyper-T.

There is a test for pancreatitis, called an fPLI test, for feline Pancreatic Lipase Immunoreactive. If he is eating, not puking and does not seem ill, he probably does not have pancreatitis. It is a painful condition and cats usually act sick with it, hence not eating and meatloafing.

Of course ECID. It seems to me more tests are warranted, which is probably why your vet is recommending an IM vet. His asthma treatment is a complicating factor. I also believe it may increase appetite and perhaps water intake.

I'm curious if anyone else thinks he might have a sputtering pancreas or one that is at least trying to wake up? Most likely his diabetes is steroid induced.

 

His thyroid was checked out in February along with a full blood work up and he had a dental back in November. In Feb, his kidney function looked ok - but I don't have any more recent data and I never got the numbers from his lab work. He went on clavamox a few weeks ago for a possible UTI infection, but the antibiotic didn't seem to effect the glucose numbers at all.

His diabetes has been an underlying condition for years. I had brought him to several vets complaining about the amount he was peeing and drinking, but no one listened to me, and I never knew to suspect diabetes. His cortisone shot back in november for an asthma attack is what pushed it over the edge enough for him to start loosing weight. His current asthma treatments only include Flovent, which is a non-systemic inhaled steroid, so should not effect his water intake, peeing level, or his glucose numbers. He never went on daily pred to get his asthma under control.

Feeding wise - I feed him as much as he wants to eat. I don't withhold food because he needs to gain a little more weight back.

As long as we are not reducing a dose due to low numbers, we hold steady at a dose for at least 3 days worth of cycles before we change. We reduced the dose rather quickly a few weeks ago because he kept hitting low numbers over and over again. I didn't want to repeat a dose that made him go down to 40.

I have been wondering if his pancreas is spuddering, or if his liver just does not like dose increases and tries to protect itself until it gets used to a higher dose.