8/17 Goose AMPS 234, +3 253, Pancreatitis flare - dose increase question?

[Anshu and Goose]

Goose was diagnosed with diabetes and pancreatitis back in May 2023.

Till a few days back, Goose was doing well. He was mostly in greens and earning insulin reductions.

Before the last reduction (on 8/13 - 1.25 U -> 1 U bid), his BG got into high 30's and I fed him a tsp of high carb Fancy feast gravy. That caused his BG to shoot up for the next 2 cycles. This high BG also coincided with a pancreatitis flare up. He started having stomach troubles and reduced appetite yesterday. I started him on Mirtazapine for appetite simulation.

The AAHA guidelines on diabetes and pancreatitis suggest the following:

Pets with chronic pancreatitis may have variable insulin requirements that increase when the patient has a flare-up and decrease with improvement. If insulin doses are increased, hypoglycemia can occur when insulin resistance resolves with improvement of the pancreatitis. Thus, conservative dose adjustments should be made, and home monitoring for hypoglycemia is ideal​

Based on the AAHA recommendation, I should go back to 1.25U to control his BG right away, but I am slightly concerned that it might bring him back to light green colors. What would you recommend?

• Food: 200 gms of Fancy Feast Chicken Pate, in 5 servings throughout the day + 1 tsp canned pumpkin daily.
• Medicines: Metronidazole 60mg daily for GI
• Following TR with 5-6 tests/ day.
• No urine ketones, stable weight around 10.4 lbs / 4.63 kgs.

We are getting a referral for a feline internal medicine specialist to discuss care for his diabetes, pancreatitis, and hairball throwing up, but that's at least a few weeks away.

Thank you for reading this and any advice you might have!

 

[Diane Tyler's Mom GA]

Goose was diagnosed with diabetes and pancreatitis back in May 2023.

Till a few days back, Goose was doing back. He was mostly in greens and earning insulin reductions.

Before the last reduction (on 8/13 - 1.25 U -> 1 U bid), his BG got into high 30's and I fed him a tsp of high carb Fancy feast gravy. That caused his BG to shoot up for the next 2 cycles. This high BG also coincided with a pancreatitis flare up. He started having stomach troubles and reduced appetite yesterday. I started him on Mirtazapine for appetite simulation.

The AAHA guidelines on diabetes and pancreatitis suggest the following:

Pets with chronic pancreatitis may have variable insulin requirements that increase when the patient has a flare-up and decrease with improvement. If insulin doses are increased, hypoglycemia can occur when insulin resistance resolves with improvement of the pancreatitis. Thus, conservative dose adjustments should be made, and home monitoring for hypoglycemia is ideal​

Based on the AAHA recommendation, I should go back to 1.25U to control his BG right away, but I am slightly concerned that it might bring him back to light green colors. What would you recommend?

• Food: 200 gms of Fancy Feast Chicken Pate, in 5 servings throughout the day + 1 tsp canned pumpkin daily.
• Medicines: Metronidazole 60mg daily for GI
• Following TR with 5-6 tests/ day.
• No urine ketones, stable weight around 10.4 lbs / 4.63 kgs.

We are getting a referral for a feline internal medicine specialist to discuss care for his diabetes, pancreatitis, and hairball throwing up, but that's at least a few weeks away.

Thank you for reading this and any advice you might have!

Tagging @Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

previous post for continuity https://felinediabetes.com/FDMB/threads/goose-new-member-summary-dc-may-2023.278782/#post-3095397
He had green BGs on the 1 unit dose 2 days ago, which was 4 cycles after the reduction, then he had some tummy issues. I would be inclined to keep the dose at 1 unit for a couple more cycles to see if he comes back down again. Keep posting so we can see what is happening.