Ty 6/17 - AMPS 204, improving, but still not interested in food :(

Previous threads here:
http://www.felinediabetes.com/FDMB/threads/6-15-updates-on-ty.215701/
http://www.felinediabetes.com/FDMB/threads/please-help-kitty-with-ketones.215641/

Background: Ty has been hospitalized twice for DKA in the last 1.5 months. On Thursday of last week he tested positive for ketones again and we were worried sick. Everyone on FDMB helped us so much and we were able to get the ketones away. Though I am still on the watch for ketones, we are now worried about his eating and GI issues.

Ty is doing OK today, but there is still room for improvement. We'll start with the good stuff first:

• His numbers are back in the 100s today after two days of high (300+) numbers
• He came out to the kitchen this morning (hasn't really left the bedroom for days) while I was feeding the other pets, and was looking for food
• He is currently ketone-negative
• He has continual interest in food, and is currently taking mirtazapine and cerenia
• He is walking around, jumping on the bed, and generally acting fairly normal... just run-down

Now the bad stuff:

• Despite interest in food, he really won't eat much beyond a little bit of deli turkey. I've tried his favorite FF Tuna delight trays, another brand of Tuna cat food, ground turkey that I cooked up for him, his regular food, baby food, other cat food... he will sniff most of it but then just not eat. He goes for the deli turkey but won't eat too much of it at once. I've continued to syringe feed him his regular FF pate so that he gets calories. All of this despite the cerenia & mirtazapine. He does keep down all of the food (no vomiting). I am cooking up some chicken breast for him now in the instant pot... hoping that he will like it.
• He still has diarrhea. I have been mixing a little bit of pumpkin into the syringe food and that seems to be hardening his stool a little bit. I also got probiotic (S. Boulardii) which I mixed in today. Too soon to tell if that is working. But his tummy is definitely not feeling great.
• He is also avoiding water. I have been spoonfeeding it to him so that he doesn't get dehydrated.

Questions:

• Any other suggestions to get him to eat? Could he still be nauseous? I read that cerenia can cause side effects of anorexia and diarrhea. I'm wondering if I should still be giving it to him if it's not helping his nausea and possibly leading to other side effects...
• I have gabapentin (he used to take it before regular vet visits because he would get so anxious). Would it be bad to give him some? I think at least part of his refusal to eat is anxiety/aversion to food because I've been syringe feeding him. He has always been a little bit of an anxious cat. Wondering if this will help or hurt... or have any negative interactions with the other meds he's taking.
• I've also noticed that his #s look the best the day after I gave him an extra bump of insulin (6/13) and after I shifted his dosing schedule an hour earlier yesterday evening (6/16). Does this information have implications for our dosing at all? Too soon to tell?
• Of course there is no way to know, but could this be a 'long' case of acute pancreatitis? How long do symptoms of that last? We are torn on what to do next. We want to keep helping him especially when he is still acting generally happy, but what we've been doing is not sustainable forever. Anything advice is much appreciated. It is so hard to know what the right thing to do is.

Thank you all so much for your help.

 

I can't answer the questions or advise, but I can and am sending lots of these
You are working so hard, bless you.

 

Thank you

 

Update: Got an Rx for ondansetron. Fingers crossed that it helps.
Also confirmed that it is OK to give gaba with the other meds, so going to try that, too.

 

Hope the new meds do the trick!
When you get a chance, you should add the DKA to your signature along with what meter you are using. That way whoever chimes in to help will have that important info.

 

Updated. Thank you for the suggestion.
We are using the AlphaTrak 2 meter currently, but had to get a human glucometer (Freestyle 2) for 6/16/19 & 6/17/19 because we ran out of AlphaTrak test strips and our online order hasn't come in yet. @Marje and Gracie suggested using a human glucometer, but we've had trouble with ours because it requires large drops of blood that are hard to get from his ears. Does anyone have recommendations for human systems that don't require as much blood?

 

I use the ReliOn Prime from Walmart. I think there are others here who use it too. Saves alot on strips and only needs a tiny amount of blood. My vet wasn't happy about not using the Alphatrak but he is not paying $50 for 50 strips vs $18 for 100 strips. Alphatrak readings do run higher but if you have a relatively stable cat and can get away with testing only twice a day then AT strips may be ok. But if you have one you are trying to regulate and have to test very often, it can get really expensive! You can slways buy a pack of AT strips to spot check periodically. Plus selfishly, since I was diagnosed with insulin resistence recently and though its not required, I check my bs daily. This way I can purchase strips with my HSA. I am not sure animal meter strips can be bought that way. It helps a little, when everything else is out of pocket.

 

Hi there! First, I use the Relion Prime and it saves a bundle from the AT2 strips.

Question: Did you give 1 unit today? Nothing on the SS.

My Bubba when he might have been in a pancreatic flare up, had mostly diarrhea and very little vomiting. Most cats have mostly vomiting and a bit of diarrhea. EVID so it is hard to answer your question and know for sure.

Do you have any fortiflora? I swear by that stuff to get kitties to eat. It is sold as a probiotic but it is a very low quality probiotic and I would not use it for that. But, when you need a kitty to eat, it does the trick, or does with Bubba and Forrest, GA.

 

I’m glad you have got the ondansetron and hope it makes a difference. It’s hard to know if it’s pancreatitis as well. But treatment is the same as you are doing at the moment for the post DKA in that you give pain meds, anti nausea meds, apply stimulant if needed and make sure hydration is ok. Keep checking for ketones and looking for foods he will eat. Some cats take longer than others to start eating again. Sheba always lost her appetite with pancreatitis, and occasionally diarrhoea.
You are doing a great job looking after him.

 

Might try Hills a/d. Have to get it from your vet office or an RX and get it from Petsmart with onsite vet if your vet doesn't carry it. It is high in calories and can be thinned to syring too.

The a/d was my go-to when all else failed.

Tiki mousse is also a loose food. Gizmo wasn't too enthused with it but added a little tuna water and got him to eat some.

Liver shake-
Here is the condo where I wrote about the LS.
http://www.felinediabetes.com/FDMB/threads/02-10-18-texas-gizmo-pmps-199-2-210-4-5-161.190947/

Here is the link to how to make
http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

 

It took 6 weeks for Olive to come out of her p'titis episode beginning of the year. She was very lethargic, very stinky poo soft, greasy looking, in pain, occasional vomiting early on, nausea but did eat about half her food. We did weekly B12 shots (now every 3 weeks), subq fluids twice a week (which I still try to get in her), cerenia, ondansteron, bupre which she will always be on now, gab but she was on that before, not on it now. Just have to keep at getting symptoms under control and you will turn the corner.

 

Thanks for the tip. Will definitely look into this.
100% agree - it is tough to justify spending $1 per strip when were going through $50 worth in just a few days. I may try spot-checking with AT as you suggest.

 

Thank you so much. It is helpful to know that it took so long... and that she eventually turned a corner (so glad that she did). I have to remind myself that we're on his timeframe, not mine. I was expecting for him to turn a corner by now but I guess that's unrealistic. I am just very grateful that so far he is stable - not getting worse - and has no ketones! (checked again tonight).

 

Just remind yourself he’s come a long way since you first posted!

 

Thank you!! Oh man. I am going to have to work myself up to making this shake for him... haha. I don't eat meat, so having to be close enough to Fancy Feast Pate while I syringe it into Ty's mouth has been quite an experience . But this seems like it is worth a shot.

 

Yay!

 

Yes, I gave 1 U today (and another just now). I thought I had updated the spreadsheet but I guess I did not. I fixed it. Sorry -- still learning, and trying to keep track of too many things too many places!

 

Very true. Thanks to all of you

 

He has always been a fickle pickle so I guess I should not be surprised that it is taking him time .
Meanwhile, my two ladies (dog, Sadie, and cat, Rory) want to break into the bedroom to get at all of the food I am offering to Ty. They think it is very unfair that they are not being offered all of these special treats

 

I’m sure they do think it is unfair but aren’t they getting the refused foods?
One of the hardest things with looking after a sick kitty is when they won’t eat. Did he eat the cooked chicken breast? I hope the ondansetron makes a difference.

 

Unfortunately for them, no! Into the garbage it goes
I hate throwing away food but Rory is too overweight... we have been trying to get her to lose a lot of weight for years and it has come off very, very slowly.

He refused that, too. Deli turkey is the only thing he will go for so far...
I just picked up the ondansetron this evening, so he just had his first dose. Fingers crossed that it helps.

 

Have you tried scrambled egg?

 

Yes. He was not interested.

 

I didn't have to syringe the Liver Shake. He ate it on his own. But it can be syringed if necessary. I always gave Gizmo the option to eat on his own and only if complete refusal did I force feed. He would also eat the a/d on his own (usually). You may try free feeding until he starts eating better. Just realize that AMPS/PMPS may be food influenced.

I hate pancreatitis. It is such a cruel disease.

CBD also seemed to help a lot.

 

Hi.

Have you tried mirtazapine? It was originally developed to control nausea but then found to be very effective at stimulating appetite. Last year a transdermal form was approved by the FDA. I believe you just rub it on the inside of their ear. We've used it in the past when my T has had pancreatic issues & it was extremely effective....like as soon as it hit him he was making a move to his food dish! We typically start with Cerenia if he seems nauseated but if that doesn't help enough & he's still limited with what he will eat we add the Mirtazapine as well. I'm not sure if the cerenia is causing side effects in your case or if adding the Mirtazapine would help.
A/D is also a great recommendation. Haven't had to use it with T but I had another with renal failure in the past who would eat that when she was really sick.

Here is the link for the info pertaining to the release of the transdermal form. A friend of mine used it because his cat was not good with pills. Hoping things improve soon.

https://www.vet.cornell.edu/departm...lth-news/fda-approves-appetite-stimulant-cats

 

Thanks for the suggestion! He is currently taking the pill form of mirtazapine. I think it is making him hungry but he's still not making a move for most foods...

 

Found another food that he will go for... Friskies canned food w/gravy. He specifically is licking up all of the gravy and leaving most of the bits of chicken.
I know this isn't good food for a diabetic kitty bc it is high carb, but I'm letting it have it for the time-being if it means he will eat. I might try putting some of the gravy on top of his other food to see if he will go for it.

 

If he likes gravy food, try THIS one. According to the ingredients, gravy in it is really just added water, so should still be low carb. My kitties love it!

 

The other thing I've done is add a little water & heat up the food. I also use a smasher made for making homemade baby food (or you can use a fork but the baby food smasher works better). This makes it more easy to eat & digest. Kind of like a thick soup or stew.

 

Thank you!! That is the one he's liking, EXCEPT he had the chunky kind (not the pate), and wheat gluten is one of the main ingredients :-|. After you posted this I picked some of the pate up for him after work. He liked the gravy but not the actual pate! Agh! I was hopeful.

Things are definitely improving with his appetite - I think the ondansetron is helping. Definitely not back to normal, and still very picky. Baby steps.

Another question for you all -- my numbers today are spotty, but today (6/18) and 6/15 & 6/16 look a little bit like bounces to me after blue days.
Trying to read through all of the helpful info. on this site, but haven't found it yet. Do bounces indicate anything about dosing? The need to go up or down in insulin amount?

 

He does look like he is bouncing from the blue numbers. He is just not used to being in blue numbers and his body is dumping glucose and regulatory hormones into his system because he thinks the blue numbers are too low for him. He needs to get used to lower numbers again.
Insulin is dosed on the nadir not the bounces.
I’m wondering if he should go up in dose 0.25 units. How’s his appetite now? Is it improving much?
What do you think about an increase @Sienne and Gabby (GA) after he comes off the bounce?

 

I have to laugh at this, I grimaced scrolling by the term “liver shake” and it’s been weird enough having to feed so many cans of meat to the cats, as the cats are the only meat eaters in the household here. I wish you so much luck. You have my sympathy.

 

I agree with @Bron and Sheba about raising the dose after the bounce clears. Remember, though, if you're giving Ty HC food to get him to eat, the higher numbers may reflect the HC food.

Do you think he's not liking the pate style food? Some cats don't. If that's the case, see if he'll eat Tiki Cat. There are a good number of LC options and many of the varieties are shreds rather than pate.

 

True. It's so hard to know because his schedule is off. On one hand he's eating a little less than usual, on the other hand it is HC. For that reason it is probably good to wait for now until he (hopefully) gets back to his normal eating schedule.

He used to LOVE FF pate (actually, any canned food) until this weekend when he stopped eating much. I started syringe feeding him last Friday because he had trace levels of ketones, wasn't eating a ton, and we were trying to flush them out. So I think it might be an aversion thing...
Will definitely check out Tiki Cat. Anything is worth a try at this point.

The good news is that he is going wild for the Friskies HC food and eating any of it that I give him. So his appetite is at least back.

 

Weruva chicken frick a zee is like the Tiki food. Shredded chicken in sauce. Low carb.

Also can try this VE, use the mini parties and crumble it on top of wet food. If he likes it by it self you can mix a bit of water to any texture. Complete meal and low carb. In turkey, chicken, duck or even rabbit. Turkey is the favorite here yet they won't eat any canned turkey, go figure. Chewy has it.

 

Wow. Ty is full of surprises for me.
I didn't give him a full unit of insulin this morning (his usual dose) because his AMPS reading was 187 and he had low (for him) BG all night. I was not going to be home for most of the day and was worried about hypoglycemia, so I conservatively only gave him .25 U.

Much to my surprise I get home and his current BG reading is 94 (+7 AMPS). This is even after leaving HC food out for him to snack on when I left this morning - which he did.
A little scary because I don't have his other AMPS numbers, but also a little exciting because he is doing so well and this is the lowest reading we have EVER gotten from him since he was diagnosed in February!

 

Whoo! Congrats on the new low! We got one today too!

 

Congrats!!

 

Fuzzy says thank you, everyone, for helping me feel super good today! I celebrated by walking around the house for the first time in days and jumping on the bed to lay with my mom.

 

What a sweet face!!!!

 

Give yourself a well-earned pat on the back for this, too, Cynthia! His improved health is a direct result of your hard work and loving efforts.

I know how good it feels to celebrate those moments like a snuggle or a jump or even a short walk. So glad he is having a better day.

Chin scritches to you, Ty! I like your kitty face!!!!

 

A question for those of you with more experience -- how long have you continued with ondansetron/mirtazapine/cerenia after kitty is eating on own/seeming ok? I don't like the idea of keeping Ty on meds for too long, especially when he seems to be doing better. But I don't want to take him off and have his troubles come right back.

 

I haven’t had to use those meds much, but when I did, I gradually cut back dosage and if I saw things going downhill, I went back up. How often and what dose are you giving? Hopefully others will chime in with better info!

 

OMG SO CUUUUUTE!!! I can’t handle it,he’s SUCH a handsome man!!!! I love his little face and the way he’s holding his front paws.

Major case of cute aggression going on here