5/25 Butch AMPS 151, +2 72, +3 78, +4 87, +5 77, +6 83 +7 105, +9 153, PMPS 209

Hello,

Butch had a blue and green day. His appetite wasn't much, he didn't want his FF classic this morning before shoot so he settled for almost a whole tilapia filet. After his shot, he then felt like eating a 1/2 FF can. I decided to start back the Mirataz gel at +3 (11:30 am). He snacked (tsp or 2) throughout till +6 with chicken breast & FF classic. Good appetite at PMPS finished his can FF classic

Madeline and Butch
https://www.felinediabetes.com/FDMB...166-1-180-2-222-6-286-11-375-pmps-313.290380/

 

Good to see him back in green!

I haven't gone back and read previous condos, but what is the reason for his inappetence?

I think you have room to increase. Will help him clear bounces faster and spend more time in lower numbers. Tagging @tiffmaxee and @Wendy&Neko for their advice.

 

I went back several days but did not see the reason for inappetence. Do you have a diagnosis? How is his weight? Seems like he ate well before the mirataz. With my cats inappetence was due to nausea.

I do think you have room to increase.

 

@Bandit's Mom It sure is!

Prior to his hospitalization May 3-5, I was not testing, he was originally on 1u went for a spot BG check (+6 2:30 pm) at the vet and my vet decided to increase to 2u. He was on the 2u for a week, did another spot BG check, and vet increased to 3u. He was on that for about 5 days still eating great. Then on May 1, in the evening didn't want to eat much. In the morning didn't want to eat at all and threw up whatever water he had drank that morning. I did not shoot that morning because he wasn't eating and brought him to the vet (11:30 am) BG check at the vet 170, urine dip showed no ketones, no fever, and his labs were taken, and he was given Pepcid and Cerenia injections. He ate a little that night so I gave him 2u, but in the morning he would not eat again. My vet office had no vets in the office that day, so I took him to the hospital. He was admitted and discharged on 1u with the Libre. Also, Cerenia tabs and Mirataz gel as needed. After a few cycles, he increased to 1.5u. I do get a little paranoid when I see his appetite is less.

@Bandit's Mom Thank you Butch ate well this morning. I'm not sure if he's sick of FF classic. 5/26 AMPS 177, +3 67, +4 52 Advise would be very much appreciated. @tiffmaxee @Wendy&Neko I added his 5/2024 Labs. Did a urine test strip at home yesterday no ketones or glucose in urine.

Madeline & Butch

 

@tiffmaxee I am still not sure of the reason for his inappetence. I tagged you with some history of what led us to the hospital on 5/3-5/5 and added his recent labs. I continue to give him cerenia 1/4 tb daily. What did you do to help with the nausea and inappetence?

He ate this morning but gave me a little scare yesterday morning and I didn't want to take any chances (I do get little paranoid) so I gave the Mirataz gel. I think he's tired of the FF classic. He smelled the FF grill was going nuts over it. I think I might have to change it up.

He BG today AMPS 177, +2 61, +4 52

Madeline & Butch

 

I find for nausea ondansetron works well. It needs to be given every 6-8 hours. Are you cerenia tablets 16 mg? I think it’s being dusted too low. Many vets do not give enough. Did the vets test for pancreatitis? Max had chronic pancreatitis so it came and went. There’s a specific blood test for it, SpecfPl. It’s very common for diabetic cats to have it. In my case Max had it for over two years which possibly was a cause of him becoming diabetic.

With that 61 I think I would not increase just yet. See if he will eat on his own. I think he needs ondansetron as it works better for nausea. How much does he weigh?

 

The ondansetron dose is 0.5-1.0 mg/kg 3-4 times daily. It seems to take about 30 minutes to work but wears off in about 4 hours.

 

@tiffmaxee Cerenia tb 16 mg. A PrecisionPSL 29 (HIGH) on his lab report. I will inquire about ondansetron when they open on Tuesday. His weight is almost 16 lbs.

He is snacking on tilapia but not the FF classic. With a +4 52, should I give some FF grill?

 

Thank you

 

He has pancreatitis. We have a whole lot of info on it that I will link. The treatment is to control symptoms which usual are nausea causing inappetence, pain medication and buprenorphine is best, feed small amounts often and add water to food. Sometimes sub-q fluids are needed. Once the nausea is controlled you won’t need the mirataz. If you stimulate the appetite without controlling nausea they can develop food aversions which is why you were in the right track when you said he might be getting tired of ff.

 

Here’s the link.

https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.79693/

 

I looked quickly at the labs. The SDMA is high which could mean early ckd BUT he’s not well and I would just keep an eye on his creative, BUN, and urine specific gravity which is low right now. Get him feeling well and retest in 1-3 months is what my vet would suggest. You don’t determine based upon one set of labs. I say he has pancreatitis with the one test because of the symptoms. I’ve had that particular test read high when my current cats were not symptomatic but with symptoms I think it’s highly likely.

 

@tiffmaxee I wanted to give him a snack with his # in the 50's. He ate the FF grill with no problem. I offered about 2 tsp of it. I got him to eat about 1/4 can FF classic with a little Forti Flora on it. BG +6 91

I'll speak with my vet regarding the SDMA and pancreatitis. While he was in the hospital an ultrasound and chest Xray (heart mummer) was done. The image was sent to my vet but not the report. I spoke with the hospital, and it will reach my vet this week

Hospital discharge diagnosis:
Diabetes mellitus - unregulated
Mild segmental enteropathy - rule out inflammatory bowel versus small cell lymphoma
Hepatic nodules consistent with benign cystadenomas
Questionable pancreatitis
Scant bicavitary effusion

@tiffmaxee Thank you! .

 

@tiffmaxee Could the Solensia injection that he gets cause a pancreatitis flare up?

 

I dint think it would cause pancreatitis but if too large a dose could cause diarrhea it says in the literature.

It will be good to get the report from the ultrasound as if pancreatitis it should resolve without treatment other than what I wrote above. IBD or SCL requires a biopsy to get a diagnosis. One of mine was suspected having one but her biopsy unfortunately was either mishandled or an endoscopy did not reach the right part. I changed her protein and she was put on prednisolone and she recovered I think she’s been off prednisolone fur about 3 months. I’m rather upset I don’t have a diagnosis and if symptoms reoccur she will need a surgical biopsy. I would have fought fur a refund and the surgery but steroids can mask lymphoma.

 

@tiffmaxee does prednisolone cause BG to rise? Butch doesn't have any diarrhea. He is usually constipated. I completely understand. I would be upset too. Hoping that symptoms don't reoccur.

Tonight, once again he wanted nothing to do with the FF classic, so I fed him the tilapia filet, he almost ate the whole filet before PMPS. PMPS 348, not sure if it's a bounce or from the 2 tsp of FF grill today. Hoping tomorrow he's feeling better

Madeline & Butch

 

Prednisolone can raise the BG. Fortunately my cat that was on it was not diabetic.
Max with chronic pancreatitis never had diarrhea either.

Nor all cats with IBD or scl have diarrhea. Some have constipation. Many are ravenous while others inappetent. I’m not sure why IBD or scl is suspected with your cat. It seems it’s just as likely pancreatitis. Wonder why that was not mentioned.

 

@tiffmaxee I brought the labs from my vet with me to the hospital because they were done the day before. The hospital suggested the ultrasound. They said nothing was alarming with questionable pancreatitis. I'll definitely discuss all this with his vet. Thank you for sharing. I really appreciate it.

Do you think the rise of his BG is a bounce or from the FF grill?

I was giving him MiraLAX but stopped because I thought that might be bothering his stomach. Is MiraLAX okay to give?


Madeline & Butch

 

He is bouncing from the 50s. FF grill I think is higher carbs? (Sorry, I'm not in the US) If so, feeding higher carbs later in the cycle can reduce duration of the insulin which in turn contributes to the bouncing and leads to higher preshots at the end of the cycle.

For future reference, he had flattened out between +2 and +4, so he didn't need higher carbs at +4/+5. You want to feed them earlier in the cycle when the insulin action is strongest and you can slow drops. Going by his AM cycles yesterday and today, I would feed a part of his breakfast at +1 and see if that reduces the dive at +2.

It is fine to give, but constipation is one of the side-effects of kidney issues. Any chance he is dehydrated?
https://felinecrf.org/constipation.htm#peg3350_miralax

 

Miralax is completely safe. I gave it to Max. Pancreatitis is not a fun disease but better than scl and IBD provided they respond well to treatment. It would likely be chronic which comes and goes. An acute episode is as serious as the other two but that’s clearly not the case here. I would not worry about if he has it. It just might explain what’s wrong and rule out the other two but you need the full ultrasound report to see why they are thinking IBD or lymphoma.

 

@Bandit's Mom Thank you! I just did a dehydration test. I don't believe that he is.

 

@tiffmaxee Thank you! I'll follow up with the hospital to make sure the report is sent to the vet office to discuss all with him. Butch is almost 16 lbs. 1/4 tsp 2x daily Miralax is enough for his body weight?

 

Miralax is a dose to effect med. If you aren’t getting the right effect try twice a day. There’s a really good site on feline constipation. I’ll get you the link.

 

https://felineconstipation.org/prevention.html

 

@tiffmaxee Thank you so much!