Previous thread: https://www.felinediabetes.com/FDMB...please-advise-do-i-shoot.264993/#post-2967743 Hi, everyone, I kind of tried to take a break yesterday from thinking too much about the diabetes other than doing the normal BG checks and giving her shots. Got a bit more rest, cleaned the house, caught up on regular things that needed to be done around here, and that was great. She seemed to do pretty well yesterday; was out and about a lot and eating really good on her own. I have noticed lately, though (past several months), that she doesn't want to jump as much and when she does, she seems kind of shaky or weak. I wonder if that's a type of neuropathy or maybe arthritis. Hope she didn't hurt her neck somehow; when she was examined before, the vet moved her neck around and said everything was okay, but she seems to wince sometimes if I feel around her neck/shoulder area. I asked another vet if they noticed anything and they said no. She otherwise lays around and contorts herself in normal cat ways so you'd think nothing is wrong, so who knows; that's the mystery of cats. Just trying to figure her out. I did pick up calipers and was playing around with them but not sure I really like them so we will see. When I talked with the teaching hospital vet Friday, she made out like there's nothing more we can do for her pancreatitis than what we are already doing, that none of the meds come in liquid form, that they don't give fluids or really do anything else unless the cat is eating nothing, and even then, there's not a whole lot they do in the hospital. She said there's no magic pill to suddenly make her better, which I know but I just feel like there's gotta be more? When I asked about the ultrasound and could she have IBD or anything else going on, the vet said it's possible but because she's diabetic, they couldn't treat any IBD anyway since the treatment is steroids. All she could sum it up to was that having a diabetic cat with chronic issues is stressful and all you can do is try to make them comfortable and that's about it. Frustrating. Haven't seen anymore blue numbers on the 3 since perhaps Thursday; I can tell looking at the Libre graph that she may have hit around 190 or 180 a couple times, but they were not scans so I don't have the exact numbers. Yesterday's PMPS was decent for her (239), but other than that, she's been pretty high. Could it be that there are some lows she's still reacting to by bouncing? I thought the 3 was starting to work really well but it seems any time she gets a decent number out of it, back up she goes for a while and then the 3 seems to be doing blah. What do you guys think?
She's still in the 300s. I don't understand why it's not dropping?? And now the sensor is giving a lot of 10 minute errors so that doesn't help.
I think a compounding pharmacy can turn most meds into a liquid form. I've used Wedgewood compounding pharmacy in NJ for my dogs meds for years now. They're mail order and they've been great. I saw that chewy sells the subQ fluid bags but no idea if they require a prescription or not. I'm not recommending you give subQ fluids without a vets guidance, but thought I would throw that out there. Sorry the vet is being dismissive. Maybe it's time to do a little "vet shopping"
Okay. It’s total Bologna (this is the nicest, most polite term I could think of) that a diabetic cat cannot be treated with steroids! If there is IBD present, then it needs to be treated. First line is to try a novel protein diet, meaning a protein that she has never eaten before. This will help some cats. If that’s not enough, then steroids are warranted! Will Prednisolone influence BG? Yes. Can insulin be adjusted to compensate for that? Yes. Sorry if I sound irritated. I am irritated at that really unhelpful vet. Why do I get the impression that she doesn’t want to be helpful to BabyG at all!!!???
Take a look at @Katherine&Ruby spreadsheet. Ruby must take Prednisolone for her IBD, yet she still is very well controlled in her diabetes. Even the last few weeks while Katherine has been out of town look pretty good. Almost all blues and greens. https://docs.google.com/spreadsheet...JUiVX87H-YOj5-lZYu3yHgXosQudHNFRKd6T-/pubhtml
I think so too. The problem is I've tried a couple vets already and they all kind of sucked. Two dismissed and ignored weight loss signs, and then there's the one I mentioned today that's a vet at a teaching hospital, so go figure. Will have to keep looking. It's difficult too because there are not many animal clinics out here and I have to travel for everything because I live more south. That's the impression I got, too. She was also irritated because I had called her again, and I had only called her again because she never returned my first call the previous day and I was concerned about my cat and needed answers. She just seems to have given up on my cat and I don't know why; I think all of her problems, though they suck, are manageable; I just need help managing them and that's what she's supposed to be there for.
I agree with John. Wedgewood Pharmacy is really the best. They make compounded flavored liquid medications and a lot of transdermal meds too (that are rubbed on the inner ear). This is total nonsense about “all you can do is make them comfortable!) please tell me what medication BabyG has been given for pancreatitis, if anything. Normally, sub-q fluids, Cerenia and anti-nausea meds, pain medication if she’s hurting, are all prescribed for pancreatitis. How was her pancreatitis diagnosed? What kind of test? What makes you suspect IBD? Please forgive me if you told me this before!
https://www.felinediabetes.com/FDMB/threads/06-26-baby-g-7-368-10-395-pmps-322.265074/#post-2968629 Her glucose has been so high today and I don't know why. The 3 was doing so good before! What is wrong now. Also, her sensor failed (we were supposed to have 5 more days ). I feel so lost and scared without it. I know I can check her any time with my meter but it's just not the same; I'm not getting the same amount of data, and I don't want to poke her too much either for it. Not sure if I'm going to get a new one put on or not. She hates going to the vet, and I have no idea how long the next one will last so that's another factor to consider. Not sure if I will break the bank and buy the stuff to try doing it myself because then I worry I might hurt her as I've never used clippers before. Definitely something I've got to think about.
I wouldn't have gotten anything if I hadn't asked for it, which also bothers me. I think the vet should have on her own prescribed us stuff. We have Gabapentin for pain, mirtazapine for appetite, and ondansetron for nausea. When I asked about bupe, cerenia, fluids, pepcid ac, or b12, they didn't want her to have those. Now shes not taking anything; she's eating good at the moment, but what if she starts having problems again since it's supposedly chronic. I want to have an at-home kit that works for her. She was diagnosed based on GI panel. Only reason I asked about IBD was because her ultrasound showed thickened intestinal walls, but none of the vets actually said she had it.
Tomorrow is the 7th day on 3.0. It just looks like you haven’t hit the breakthrough dose yet. Can you do a curve so we can see mid cycle bg? It looks like unless you see blue or green you can increase to 3.25. You aren’t doing anything wrong. You got a 212 the other morning. That’s improvement. I never used Libre as I don’t think they were yet available. If you can get a +2-3, which will likely be onset, you will then know if later tests are needed.
I know the dose had gone back and forth a little in the past, but we had gotten blues before on the 3 so I guess that's why I'm confused as to why we aren't getting any more. I'll check her at +2 and let you all know where she's at.
Oh yes. Now I do remember. Thickening in the intestinal layers is, by definition, Inflammatory Bowel Disease. So she had the GI panel and an ultrasound. GI panel also can point toward IBD and then you backed it up with the ultrasound. You definitely need a new vet! It’s so hard to find one these days and also a lot of them aren’t accepting new patients.
They often go up and down. It’s frustrating. Holding a dose too long often means more insulin is going to be needed. You are following SLGS so that’s what sometimes happens. With TR you can increase sooner and get to a breakthrough dose more quickly but that requires a minimum of two tests per cycle and mid cycle tests at times and that means both cycles. Since your kitty eats some dry food you need to follow SLGS though. You will find a good dose it just will take longer.
You have held this dose long enough, according to SLGS rules, with nadirs greater than 150, you can increase to 3.25 units. Did she get a new Libre sensor? Try to get a +2 test at least before you go to bed. If the +2 is a lot lower than your preshot number then it could mean an “active” cycle (will keep you busy) and you would need to set an alarm(s) to scan or test her/feed/intervene, etc. On SLGS you should do a curve where you test every 2 hours for 12 hours - to see how low the dose is taking her.
I understand her insulin needs can change if she has more health issues that interfere (like infections, pancreatitis, etc.), but if everything stays the same, shouldn't she eventually be able to have a dose that she can hold for a long time? She was on the 2 units twice a day for years. Granted, it didn't give her the best numbers, but the vets at the time were happy with it because her clinical signs were good, so it never was changed until recently with this new situation. I'm hoping to get her on a dose that (so long as nothing else health-wise interferes) can be "her" dose that she sticks with for a while. Not sure how realistic that is?
Some cats get regulated and stay on a dose but many need adjustments weekly. I guess you want to be under renal threshold where there aren’t symptoms or glucose spilling into her urine.
The sensor ended up failing today. Only got 9 days out of it. Debating if I should get a new one put on...she hates going to the vet. I've considered acquiring all the equipment to do it myself but it's expensive and I'm worried if I might hurt her. Some people say oh it's easy and then others warn about the dangers of snagging/cutting their skin. I feel very lost and afraid without the sensor, though. It easily gives a lot of data I wouldn't otherwise have. I would probably want it if I'm going to up her dose at some point again. She had one cycle with a nadir below 150, but haven't seen anymore like that.
Yes. I see the blues under 150 on June 18. I always heard that if your Libre fails early that the company will give you another one free of charge.
+2 is at 351 vs preshot 365. So if I'm understanding right, since it's lower than the preshot, sounds like we should have an active cycle and I should check every 2 hours or so? Edited to add: sorry, yep...I see I need to do every 2 hours for the full cycle.
I think I will call and ask (but not mention that it's for a cat; I heard they don't like that). Her +2 is lower so sounds active and like a curve needs to be done. This would have been a good night for the sensor. I'm glad my cat is really good about being tested (she runs to me when she hears me unzip the bag with the testing supplies); I just don't want to overdo it but no choice right now.
You don’t need to do a full curve. Your +2 is not much lower than the pmps and with meter variance could be flat even. Get a +4 and unless a big drop that might be all that you need. Feed a little lc now.
Do you think I should or wait until I get a truly active cycle with the full curve? We did get into the blues a few times on the 3 (even below 150), so that's why I'm not sure? I'm going to email her spreadsheet to the local vet (who's not great but not awful like the teaching hospital vet) and update her on Baby G's status over the weekend and the high numbers we saw.
I’d get a mid cycle and unless blue increase. I don’t think you need to stay up all night with these pinks unless there’s a huge drop. I think an increase is needed honestly.
If she needs an increase, would it be best to do it tomorrow night when I'm home instead of in the morning when I'll be at work most of the day? I don't really think .25 is going to do much but then I may be surprised. Do you guys usually try to time increases based on weekends or cycles when you're home, or do you just go for them whenever/however the timing falls? Also, the one thing that vet did say which is true is that she should lose some weight. She's a big-boned cat but is around 17 pounds. Vet said her ideal weight is 12, which I dont really agree with but I think she could carry 15 or 16 pounds well. So far I haven't been portioning her food due to the whole pancreatitis/regulation thing, but if I do portion her at some point, I'm thinking that's probably going to mean adjusting the dose yet again.
The problem is some cats react on the first dose and others can respond on the second or even tge 6th. How soon after you shoot do you leave for work? Can you get a +2 or even +1 or 1.5?
I have to leave right after. I'm slowly trying to move her shot time back to 6, but she's currently almost at 7 and I start work at 8.
If you move it back that will make it easier to decide what food to feed and leave out while you are gone. Do you have an auto feeder? If not do you think your baby could get used to one? Or do you just kea e dry food out while at work?
What are you giving for pancreatitis? I had a good response with ondansetron and sometimes buprenorphine.
I've been leaving out both wet and dry. She changes her mind. Lately she's been favoring the dry. I've never used an auto feeder so not sure how she would respond to it.
For the pancreatitis she was getting Onsansetron, Gabapentin, and Mirtazapine. But I havent given her any this weekend since she's been eating good again.
That’s how I judged Max too. If he started to be one inappetent. I know what you are going through. I wish there was more to do. Max had arthritis in his back but my vet wouldn’t treat it because of the fd.
Sorry I didn’t see this before but there’s not a whole lot of difference between 365 and 351. That would be considered flat. You should not need to worry. Hopefully you are already asleep by now.
I’m really glad that your vet even gave you Ondansetron. A lot of vets seem to really resist prescribing it. It’s most effective at anti nausea. It can cause constipation though so watch out for that. Mirataz is helpful. Not sure if Gabapentin is that great for pancreatitis type pain but if it’s all you can get and it seemed to help then good. A lot of cats with chronic pancreatitis take Cerenia daily due to its anti inflammatory properties. If you think BabyG has arthritis there are lots of things that you can try - even with a diabetic cat. Adequan injections would be something to ask the vet about. There are other things to try as well. Did she seem to feel better on the Gabapentin? (And I am thinking of the arthritis now and not so much the pancreatitis.)
I'm not really sure. Haven't noticed any major differences whether on or off the meds. I have noticed when she walks that her tail has been down lately and her back looks slightly hunched up, so not sure if because her back bothers her or her stomach, or maybe she's like that because the sensors were on her back/side area, but I took off the failed one yesterday so she doesn't have anything on her now.
This is a day late from your post, but I wanted to say this is absolutely not true. If a diabetic needs steroids, you give the steroids and adjust the insulin as needed. Which is what you do with a diabetic not on steroids too...it's just that the steroids can make insulin needs a little greater. Our Roxi was recently diagnosed with either IBD or SCL (we're not planning a biopsy to find out as she doesn't handle anesthesia well and knowing wouldn't change the treatment plan). This is to go along with her diabetes, Addison's disease (former adrenal-based Cushing's cat who had her right adrenal removed along with the tumor causing the Cushing's), chronic pancreatitis with flares, early CKD, and SIBO. Plus a possible heart murmur (no-one can say for sure...sometimes it's there, sometimes it's not and it might or might not be stress-related). Her IM specialist had us start budesonide even though she has no obvious IBD symptoms as they feel the best option is to reduce inflammation regardless of whether we're seeing symptoms or not. Budesonide doesn't work for all cats, but when it does it's less likely to affect BG levels.
