? Pancreatic enzyme for EPI causes vomiting - any thoughts?

Pants is diabetic and also has EPI and IBD. She's started barfing up the pancreatic enzyme (Viokase-V) she's supposed to get for the EPI. Not to be gross, but in case this matters, it's violent projectile vomiting within a few minutes of eating the enzyme. Has anyone else had this problem? What's the alternative?

 

Sorry, I can't answer your question. I looked at your SS and see she has high BG numbers. Your signature says she's OTJ. Am I correct in thinking you're not giving any insulin to her?

 

Yes. There's a long history here and the interplay between the diabetes, IBD, EPI, and a history of overreacting to insulin is causing a mess.

She was in remission, but was slowly losing weight. After a lot of expensive testing to rule out lymphoma, they concluded it was either the IBD or the EPI causing weight loss, and in addition to this enzyme, I was talked into supposedly low risk steroids for the IBD. Based on incorrect assurances that it would not affect her blood sugar, I started her on budesonide, which knocked her out of remission. She also recently had a minor tummy bug, which hasn't helped.

In a normal diabetic cat, I would agree that she clearly should be on insulin at these numbers, but she's just not normal. She was only on Lantus for a couple of weeks in the summer of 2017 before going into remission, and she almost died twice in a week from hypo -- her blood sugar can fall 300+ points from .5 units in under an hour.

The regular vet thinks insulin will kill her at home, even if I were able to monitor her much more closely than is possible working full time. So about two weeks ago, the regular vet sent us to an internal medicine specialist vet who hospitalized her to start Lantus. But then she dropped from 359 to ~200 while hospitalized without getting insulin. After four days of lower numbers and no symptoms, they sent her home.

They thought time (and perhaps antibiotics knocking out the tummy bug) had put her on the path towards remission without further intervention, but at home, she's back up and we're going in to the vet again tomorrow.

 

You've been through the wringer for sure! My post last night was too brief - my apologies. My cat is very dramatic as well but not as extreme as yours. He's prone to idiopathic cystitis, pancreatitis and possible IBD. He's been on three insulins, is very bouncy and a challenge to dose. After a crisis in early summer, I began giving him this enzyme/probiotic supplement (https://naturvet.com/product/digestive-enzymes-powder/) that seems to have helped his GI issues. I also switched him to low carb wet food that has no carageenan in it (Wellness brand pates). The supplement wasn't prescribed by my vet (or the IM vet I saw at the time). He's bamboozled all the vets he's seen so I work it out for myself by trial and error.

Did you attempt any dose fractions smaller than 0.5 u when your kitty was getting insulin? Although tricky you can eyeball 0.25 u and many resort to what we call 0.10 u. That's done by pushing firmly on the plunger as you insert the needle into the insulin, relaxing that pressure so that the suction created draws a tiny amount of insulin into the syringe. When you inject, put firm pressure on the plunger again and maintain it as you withdraw the needle. Believe it or not, that can give a miniscule dose that actually is enough for some cats. It's often done as owners are weaning a kitty off in an OTJ trial. No vet will ever recommend 0.25 u let alone this microdose but it can work for some very low dose kitties.

 

I think those pancreatic enzymes for EPI are very strong. How was the EPI diagnosis made? A low feline trypsin-like immunoreactivity (fTLI) result or clinically? During one of Murphy's pancreatitis episodes, he must've had a transient EPI because he had classic voluminous very light extremely foul smelling stools (the entire house stunk even though the litter box was in the basement). Thankfully, it hasn't happened again, and I now religiously give him the digestive enzymes Kris mentioned above with every meal (Kris - I am glad you started using the enzymes and that they are helping). You might take a look at the website www.ibdkitties.net - they have info about the pancreatic enzymes (in addition to regular digestive enzymes). You certainly have your hands full, and it sounds like you do a great job.

 

I'm glad you weighed in, Carol. You know more about this than I do.

 

Back off the amount of the enzymes you're giving and see if that helps with the vomiting. I had this same issue with KT and his EPI and enzymes before he crossed. You may already know this but try to mix enzymes well enough in a bit of food so it won't contact the mouth tissues much - as soon as it contacts saliva they can burn the tissue if it's stays there long. I learned to mix them in a bit of yummy food - as soon as he ate that bite, he got a good size helping of yummy food to clear it out of his mouth. It seemed to work much better.

HUGS and thoughts and prayers....it hurts our hearts when they aren't well...

 

Here's some additional tips about pancreatic enzymes from ibdkitties.net-- http://www.ibdkitties.net/pancreatitis/epi/

 

Thanks for all the input and support.

I did not. After the second hospitalization, she went into remission without further intervention. And it's been so long OTJ that I don't even have insulin anymore to try it. Maybe that's the next step. Maybe it's hospitalizing her again. Maybe it's another diet change. Hopefully the vet will have some ideas tonight.

It was low fTLI, but not super low -- it was 6.5. She doesn't have the classic litter box symptoms, she's just not able to gain/maintain weight despite eating enough calories that she should. That could be the IBD, though. Or that she was B12 deficient.

How low can you go with the enzyme? I've been doing 1/8 teaspoon in about a teaspoon of tuna, which is way less than she was prescribed, but all that I could smuggle in before the taste put her off. It did seem to help when she was able to keep it down -- before other things intervened, she gained a little bit of weight when she started it. But would 1/16 teaspoon be so little as to be useless?

 

If you look at the link I provided, how to give (and how much) is discussed at length - best of luck with this