? Pancreatitis?

Checked Julie's glucose level 4 hours post morning injection. She was at 36 (alpha Trak 2). I gave her food and called vet.
Vet said pancreatitis can bring on diabetic episodes and once she's over the inflammation, she might not need insulin.
She offered a GI panel, but it's 300 dollars and I KNOW my husband won't do it. She said treatment for pancreatitis is Cerenia and Buprinex and keeping them hydrated. Which I'm already doing. I decided I'm going to keep on with the supportive treatment, discontinue insulin and just check her glucose level few times a day.

Has this happened to anyone else? My brain is working double trying to process all this information...


For reference: diagnosed December 28th, started on 1 unit lantus every 12 hours, taking 1/4 tab cerenia every 24 hours, 1/4 mirtazapine every 72 hours, 0.14ml buprenex every 8 hours, 100ml sub q fluids every 12-24 hours.

 

Thank goodness you were home testing and caught that 36 (Alphatrak)!

Here is a very helpful link about treating pancreatitis:

IDEXX Pancreatitis Treatment Guidelines

If Cerenia doesn't help fairly quickly with the nausea I suggest asking the vet to prescribe ondansetron (the two medications target different receptors in the body to reduce nausea). Also, if the appetite is still poor an appetite stimulant may be helpful.

Re blood tests, Spec fPL and also B12/folate are valuable. A course of B12 can help a great deal (general boost; can help appetite; has an anti-inflammatory effect).

If you're planning to to discontinue insulin treatment I strongly recommend you involve your vet in the decision process (even over the phone).

Even if the diabetes should eventually prove to be transient, your cat may still need insulin for the time being (but possibly at a much smaller dose than 1.0IU BID Lantus). Careful home monitoring of her BG will give you more information about what's happening. I suggest you still test morning and evening after fasting your cat for 2 hours at the time when you would normally be giving an insulin dose. Also do some spot checks after she eats to see how food is affecting her BG levels. There will still be some Lantus stored in your kitty's body (it's a depot insulin) so watch to see if her numbers trend upwards as the depot drains. And it goes without saying that the vet needs to be kept in the loop.

Something vital to be aware of when a cat is poorly, not eating enough and in need of insulin treatment is that the cat is at risk of producing ketones and perhaps developing diabetic ketoacidosis, a potentially life-threatening condition. Whatever you decide to do about insulin, I strongly recommend that, in addition to closely monitoring blood glucose levels at home, you test your kitty's urine for ketones daily (using Keto-stix or similar urinalysis strips). If a trace result is seen then the vet should be contacted straight away for advice. Anything higher than trace is a medical emergency and the cat needs to be taken in for treatment by a vet in a hospital setting to flush out the ketones (and possibly further treatment if in full-blown DKA). Here are some helpful forum stickies:

Are you testing your cat for ketones?

Tips for collecting a urine sample


Mogs
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Her vet advised me to do everything I mentioned in my post here.

I was asking if anyone had seen pancreatitis inflammation cause a diabetic episode? That only lasted for the duration of the infection? That is what my vet was explaining. Sounds weird to me.

I am monitoring her very closely.

 

Another member here @Stephanie & Quintus is dealing with exactly that.

 

Certainly a pancreatic flare can cause worsening BG levels. Pancreatitis is a common cause of cats falling out of remission. It's discussed briefly in the following Roomp-Rand journal publication (attached below).


Mogs
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Again, I recommend vigilance with urine testing for ketones. They can build up really quickly.


Mogs
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So she's at 146 at injection time. Vet had suggested this morning holding off tonight. Would it be agreed that she's ok without injection tonight?

We were out of house most of today, but she was at 36 at noon, 4 hours post injection (as stated above). Fed her then tested an hour later at 1 and she was 96. This evening she is at 146.

Thank you -

 

The general guidelines for beginners are:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.

The 36 on an AlphaTrak was extremely low. Lantus is a depot insulin. I'd skip tonight to let the depot drain. Tomorrow morning, do not feed for two hours before the insulin is due. Test, and post on the forum asking for guidance.

 

Thanks!

 

Pre food this morning after fast: 104 (alphatrak2)

Not giving morning injection.

Will continue to test several times daily.

 

@K8e. My cat was started on insulin in September 17. She presented with UTI, & pancreatitis. Her bg at the time was 500. After just 5 weeks & basically the same treatment you have mentioned; she went into remission. No vet has said that she is not diabetic but I tend to think it was all due to the UTI that threw the pancreas out of whack. She has not had any insulin since October 14th & so far her numbers are still in the normal range. Is my cat diabetic? I will continue to ask but who knows?!? She definitely needed the insulin for 5 weeks. Good luck & I hope this helps! I still feed only wet food & young again low carb for treats.