And now...EPI!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by marisofigia, Dec 4, 2020.

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  1. marisofigia

    marisofigia Member

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    Good morning @Critter Mom @Sienne and Gabby (GA) @Aleluia Grugru & Minnie @kalypso @CB Terri @jt and trouble (GA) @Scdal , and all!

    This is my third thread for Maya (part 1, part 2), my 12-year-old companion who was diagnosed with diabetes late this summer, and whose health took a turn for the worse real quick. Diarrhea has been going on for a month now, and she only just started eating normally (she lost a lot of weight fast initially).

    I've finally received Maya's exam results and logged them in the LABS tag of the spreadsheet (I didn't see that naming anywhere, so I just added 3 rows).

    B12 is sky high, folate also. fTLI below normal. Vet says she's got EPI. And vet seems quite concerned, as if it's a death sentence...

    Maya was prescribed that she takes every day Eradia (0,26 ml of 125 mg/ml bottle twice a day), WeNzyme, and Vivomixx (half a pill). Articlox once a week.

    I wanted to get your opinions before going forward.
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Poor kitty! I have no experience at all with this. I hope the treatments help
     
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  3. JanetNJ

    JanetNJ Well-Known Member

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  4. CB Terri

    CB Terri Member

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    A quick google showed me this:

    https://www.vetfolio.com/learn/arti...t-2-exocrine-pancreatic-insufficiency-in-cats

    "Chronic pancreatitis is the most common cause of EPI in cats.""


    CLINICAL SIGNS

    Clinical signs associated with EPI in cats include the classic “big 3” of chronic diarrhea, weight loss, and increased appetite. These signs are nonspecific, however, and can occur with other conditions besides EPI, including inflammatory bowel disease (IBD), hyperthyroidism, and even occasionally with chronic low grade lymphocytic lymphoma of the small intestine. Polyphagia can also occur in cats with diabetes mellitus and with corticosteroid therapy. EPI and diabetes mellitus may also occur concurrently. There are many causes of weight loss in cats, including chronic kidney disease, dental and periodontal disease, heart failure, neoplasia, IBD, and liver disease. Also note that not every cat with EPI has diarrhea and EPI should be considered in cats with unexplained weight loss with or without diarrhea.


    Diarrhea in cats with EPI is often loose or semi-formed, voluminous, and malodorous. The feces may be lighter in color than normal, e.g., tan or “clay” colored. There is increased frequency. There is a high fat content in the feces and this can occasionally cause a greasy appearance on the haircoat of the perineum and tail head. I have also observed cats with severe IBD without concurrent EPI to have this same appearance."

    Then: (AND NOTE THE VERY LAST SENTENCE WAAAY DOWN BELOW*)

    "fTLI

    A variety of tests have been used in the past for diagnosis of EPI in cats but most have been unreliable. The fTLI assay is by far the test of choice today. There are only two assays for fTLI available worldwide. One is available through the Texas A&M Gastrointestinal Laboratory and the other is available in Europe. The current reference range for the Texas A&M serum fTLI assay is 12 to 82 µg/L, with values of 8 µg/L or lower being diagnostic for EPI. The fTLI assay quantifies the amount of trypsin and related compounds in the bloodstream. This includes trypsinogen, which is the inactive zymogen of trypsin. In healthy cats significant amounts of trypsin do not circulate in the bloodstream, whereas trypsinogen is expected to be found in significant amounts.

    This test involves obtaining a serum sample after fasting the animal for 12 to 18 hours. Serum TLI has been validated for use in both dogs and cats (cTLI and fTLI). Most cats develop EPI as a result of chronic pancreatitis. The fTLI may actually be high initially (in association with pancreatitis), and then over time it will gradually decrease until it reaches a diagnostic range for EPI. It should be noted that occasionally a cat with signs very consistent with EPI will not have a fTLI result in the diagnostic range. Usually the fTLI will be in the low end of the reference range for normal in these patients. Eventually these cats will reach a point where the fTLI is in the diagnostic range. The main point is that, if there are signs consistent with EPI and treatment for any other conditions that have been diagnosed (e.g., IBD, hypocobalaminemia) are not resolving the clinical signs, treatment for EPI with digestive enzymes should also be instituted. A positive response to therapy will help confirm the presence of EPI. The serum fTLI may also be noted to be in the diagnostic range when it is rechecked one to several months after the initial “gray zone” result.

    TREATMENT OF CATS WITH EPI

    Therapy for EPI involves dietary supplementation of pancreatic enzymes. Any concurrent disorders that have been identified must also be addressed. Supplementation with cobalamin is added if levels are low, as is the case with many EPI cats. Specific dietary therapy is not required (e.g., fat restriction to any degree).

    Most cats are treated with a commercial preparation of dried pancreatic extract of bovine or porcine origin (e.g., Viokase, Pancrezyme, Epizyme). A powdered preparation is more effective than tablets or capsules and is the only form recommended. Enteric products should be avoided. The starting dose is ½ to 1 teaspoon mixed with each meal. Cats do not like the taste and do not accept enzyme replacement powder in their food as well as dogs and so it is best to thoroughly mix the powder in canned food in order to more effectively mask its presence. If this does not work, try mixing the powder in some fish oil and stirring it into the food. The enzymes can also be packed into gelatin capsules. If these steps fail, raw pancreas can be used. Raw beef, pork, or game pancreas can be obtained from butcher shops. Raw pancreas obtained in bulk is chopped and portioned into individual meal dose sizes and kept frozen until ready to use. Fresh-frozen raw pancreas can be kept frozen for several months without losing efficacy. The dose is 30 to 60 grams of raw chopped pancreas per meal. There is no need to pre-incubate enzymes in the food for any period of time before feeding, or to add gastric acid reducing drugs.

    Most cats respond rapidly to enzyme replacement therapy and stools should be normal by 3 to 4 days after the start of therapy, if EPI is the only disorder. If there is a limited response to therapy, other problems may be present and must be treated (e.g., as previously discussed other disorders could include diabetes mellitus, IBD, villous atrophy, hyperthyroidism, hypocobalaminemia). Pure cobalamin is administered subcutaneously at a starting dose of 150 to 250 µg per cat based on body size. Injections are given once weekly for 6 weeks, followed by an injection every other week for 6 weeks, and then one more dose a month later. The serum cobalamin level should be rechecked one month after the last does. Some cats with EPI may require lifelong therapy.

    Once clinical signs have been well under control, the amount of enzyme supplementation that is provided with each meal can be gradually reduced to the lowest effective dose, which may vary from patient to patient and also between different batches of the pancreatic supplement.

    There are no studies detailing the effect of various types of diets on feline patients with EPI. In general, most cats do well on a commercial maintenance type diet. Low fat diets should be avoided because of their lower caloric density. High fiber diets should also not be fed because some types of dietary fiber interfere with pancreatic enzyme activity.

    PROGNOSIS

    EPI is associated with irreversible loss of pancreatic acinar tissue in most cases. Recovery is not expected and lifelong therapy should be anticipated. However, with careful monitoring and prompt management of any other problems, a normal lifespan can usually be enjoyed."

    A *NORMAL LIFE*. Not a 'death sentence'. It is manageable.
    It looks to me like it will require some research, for sure, and some balancing of diet because cats with EPI must have some fat in their diet and not a high-fibre diet.
    But the powdered pancreatic enzyme - the WENZYME already prescribed (or maybe better and easier to get would be raw pancreas from pork/beef/game at 30-60 grams raw & chopped per meal might be less cost-prohibitive?)) at least is obtainable. Local butcher shops or grocery chains could provide this, and it can be frozen in meal-sized portions.

    Google can be very helpful to find explanations and definitions that are clearer to understand than doctors and vets sometimes make things.

    Glad you have asked about this here, I had not heard of EPI before now.
     
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  5. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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  6. marisofigia

    marisofigia Member

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    Thank you! I feel better reading this..
     
  7. CB Terri

    CB Terri Member

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    Here is something else I saw, containing powdered pig pancreas, for cats and dogs with EPI and digestive issues. This might be an acceptable source that could be less expensive than the vet - you will want to compare the labels for ingredients and amounts:

    https://www.amazon.ca/Bio-Case-Enzyme-Supplement-capsules/dp/B000O5JWQO

    I have one cat with regular diarrhea and vomiting semi-digested food. I may get this for him but I'm going to research to see if it may be given without harmful effects to cats without diagnosed EPI.
     
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  8. Critter Mom

    Critter Mom Well-Known Member

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    καλό απόγευμα, Marisofi.

    Maya's TLI Result: 10.7 (Feline reference range: 12.0 – 82.0 µg/L.)

    (Suggestion: Maybe use the date that the sample was taken in the spreadsheet rather than the date the result was received as the 'snapshot' of Maya's status relates to the former - better for tracking and comparison of results, relationship to symptoms, diet at that time, etc.)

    Interpretation of result (from the TAMU TLI page):

    In cats, values equal to or below 8.0 µg/L are diagnostic for EPI, with values between 8.0 and 12.0 being equivocal. As in the dog, repeating the assay one month later should be considered.
    [Emphasis mine]

    My understanding is that where EPI is the big issue then frequently the associated malabsorption problems lead to low levels of B12/folate - not the case for Maya at the moment (good?).

    Of note is that every site covering EPI in cats mentions that it is commonly seen secondary to chronic pancreatitis so, in addition to starting the recommended treatment plan, perhaps keep that particular pot on the boil with your vet? See the IDEXX guidelines listed below for further information on appropriate treatments.

    EPI in Cats (PetPlace) gives a very helpful overview of EPI, including recommended diagnostics. Interestingly, they include checking for UTIs in the work-up (don't mention the relevance, but worthy of note because of Maya's UTI). One thing in particular I don't recall your mentioning is whether they carried out a faecal culture as part of the diagnostic work-up? Our member Sienne has recommended checking for these parasites:

    C. Perfrinigens Enterotoxin
    C. Dificile Toxin
    Campylobacter
    Shigella
    Salmonella
    Pleisomonas
    Edwardsiella
    Aeromonas

    (Original post here - whole thread is worth a read.)

    What's happening with Maya is very similar to what happened with Saoirse when she had her first - very severe - pancreatitis flare. I got to the stage where I despaired that she would ever have a solid bowel motion again. In the earlier part of the flare she had what could be considered classic EPI-style stools (steatorrhoea, pale, greyish-tan in colour, stank to the high heavens and back again) followed by a period of watery then somewhat thicker diarrhoea. I asked our vet to run an fTLI test for her but it came back at 136.7 (indicative of acute or chronic pancreatitis according to TAMU). The symptoms resolved in time (and never recurred). To the best of my recall I think it may have been finding a food that agreed with her that helped resolve the diarrhoea. I'll need to check back in her daily journal to see what worked for her in case there's something there that might help you with Maya.

    (Question: Did you identify an initial trigger for the diarrhoea, e.g: introduction of a different food; course of antibiotics or other meds? My apologies if you've provided this information previously and I've missed it.)

    ----------------------

    For the benefit of all following Maya's progress, here's info on the items prescribed:

    Eradia - liquid formulation of metronidazole (the active ingredient in the metrobactin Maya was on before). Licensed for dogs in the UK. Presumably similar for Greece as an EU member state? (@tiffmaxee - I believe that there are some caveats around giving cats the dog version of a metronidazole preparation. Could you give Marisofi more info about this?)

    (Question: Did your vet say why they've changed away from the metrobactin to this preparation?)

    WeNzyme - Food supplement containing pancreatic enzymes, B12/folic acid, and Enterococcus faecium (probiotic - same one as in Fortiflora).

    Vivomixx - Probiotic

    Articlox - B12 Hydroxocobalamin (All B12 injected supplements sting a little but I picked up this anecdotal report of Articlox being a more stingy preparation in a human than some other like products on the market so thought it might be handy info for you just in case Maya were to have any issues.)

    ----------------------

    Helpful links:

    Exocrine Pancreatic Insufficiency -
    Very good discussion of the condition with tips for best way to give enzyme supplements (courtesy of the excellent marvistavet.com website).

    WSAVA: EPI in Cats - "chronic pancreatitis is believed to be the most common cause of EPI in the cat."

    EPI in Cats Support Site - Information about the condition and practical tips on how to treat it, plus discussion forum.

    IDEXX Feline Pancreatitis Treatment Guidelines - Everything you wanted to know about helpful pancreatitis treatments but were afraid to ask.

    ibdkitties.net - Lots of info relevant to cats with GI issues, not just those with IBD (e.g. pancreatitis, probiotics and B12 info pages).

    [ETA: Additional link and tips below.]


    Nausea, Vomiting and Inappetence: Symptoms and Treatments - Checklist of signs to watch for: can be a guide to which foods agree best with a kitty and also act as an early warning sign of a pancreatitis flare. (Usually the faster it's treated, the quicker it will resolve.)

    Additional Tips for Spotting Signs of Pain/Discomfort in Cats with Pancreatic/Intestinal Discomfort:

    (1) A cat with pancreatitis may exhibit hiding behaviours or may sit in a 'tense meatloaf' position - possibly with a 'pinched' expression on its face - after eating a food that is disagreeable.

    (2) A cat may seek out cooler surfaces to lie on in an effort to soothe pain/discomfort from the inflammation (of pancreas and/or intestines).


    Mogs
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    Last edited: Dec 4, 2020
    Reason for edit: Formatting.
  9. tiffmaxee

    tiffmaxee Well-Known Member

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    I suggest that you join the feline pancreatitis group on groupsio. Digestive enzymes will be needed but yes it is treatable. Chronic pancreatitis can lead to this. I never had to deal with it though. It’s a small group, active enough but you won’t be bombarded with lots of messages and there’s lots of veterinary literature to read.
     
  10. Critter Mom

    Critter Mom Well-Known Member

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    It's not. With appropriate supplementation of enzymes, etc., cats with EPI can lead long, healthy lives.

    Maya's fTLI result is in the grey area, so it's possible she may not have EPI at all. As I said above, I would keep on the case with the vets about whether the root cause could possibly be chronic pancreatitis - either to rule it out or to make sure Maya gets the right treatment for it. The comments you posted about what your vet said earlier is that they regard the pancreatitis as having being completely resolved (i.e. only considering acute pancreatitis). Chronic pancreatitis symptoms tend to wax and wane in severity.


    Mogs
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  11. tiffmaxee

    tiffmaxee Well-Known Member

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    As to the liquid version of metronadozole, it is not safe for cats. Dogs can take it without issue. The pill should be used and at the lowest dose that works. The dosing scale is very wide.
     
  12. tiffmaxee

    tiffmaxee Well-Known Member

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    Max had chronic pancreatitis for 7 years and never had EPI ir IBD or triaditis.
     
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  13. Critter Mom

    Critter Mom Well-Known Member

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    Elise, could you explain a little further why the liquid version isn't safe for cats, please? (Very much want to learn about this myself, plus it might help Marisofi in discussions with her vets.)


    Mogs
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  14. CB Terri

    CB Terri Member

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    Wow!! Some great help and data above, extra bonus points from me for your highly informative post, Crittermom!!
    Tiffmaxee, good to know.

    Marisofi, I did go ahead and order some powdered pancreas for 14 yr old boy Sootie, who has had yellow and very smelly loose poops for some time.

    Reading through literature for dogs/cats/humans, it is mentioned as a supplement that people with digestive difficulties take on a daily/per meal basis.
    Also pointed out on several cat sites where raw/natural diet is discussed, is that cats eating mice/birds and small game will eat a pancreas when eating that prey. I plan to 'SLGS' with it on his food and see how well it helps him out. But I don't fear a small amount will harm him at least, I will read up on it to see recommended weight/dosages. I will post what I find here.
     
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  15. Critter Mom

    Critter Mom Well-Known Member

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    Marisofi,

    FYI, I've updated my earlier post with an additional link plus monitoring info (so you'll have all the helpful links in the one post).


    Mogs
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  16. tiffmaxee

    tiffmaxee Well-Known Member

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    Cats don’t tolerate benzodes well. So you need the hydrochloride version of metronadozole which is the pill form. It smells awful so you are best to put it in a gel cap and be careful not to touch the outside. Google this for a better explanation.
     
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  17. Critter Mom

    Critter Mom Well-Known Member

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    Thank you for the additional info, Elise. :)


    Mogs
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  18. kalypso

    kalypso Member

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    Just noting that to my understanding epi symptoms include possible unexplained weight loss, which was not the case with Maya as her weight loss was combined with decreased appetite and intake, (maybe she didn't like the diabetic prescription food?). This may not rule out an epi diagnosis, but she doesn't seem to have this symptom for what it's worth. It would be interesting to know if she gained any weight now that she is solely on wellness core and is eating enough.
     
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  19. Critter Mom

    Critter Mom Well-Known Member

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    ... plus the diabetes can lead to weight loss due to kitties not being able to fully utilise the nutrients they consume.


    Mogs
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  20. marisofigia

    marisofigia Member

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    Thank you so much for all this info!

    The stats on EPI are reassuring... So is learning the Saoirse overcame her situation...

    No, we haven't done a faecal culture.

    I haven't really identified an initial trigger for the diarrhoea. It began around the time we started giving her insulin. I had changed her food to m/d about a month before.
     
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  21. marisofigia

    marisofigia Member

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    She said that she was hoping that Maya had pancreatitis, but now it seems that she has gone one step further...
     
  22. marisofigia

    marisofigia Member

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    That's scary! I'll go to the pharmacist tomorrow to check if they have that in pills...
     
  23. marisofigia

    marisofigia Member

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    She started losing weight before I had her on prescription food. She hasn't gained any weight but, to be fair, she's only been on Core for the past 3 days.
     
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  24. Critter Mom

    Critter Mom Well-Known Member

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    You might possibly need a different Rx from the vet. It might be worth asking your vet about whether Stomorgyl 2 might be an option. Our vets prescribe it in preference to Flagyl because it apparently doesn't taste quite so bad. It's listed as a treatment for oral and periodontal infections but presumably because it contains metronidazole it's also OK for GI issues.

    Another thought came to me: when Saoirse was seen by an internal medicine specialist re pancreatitis and liver issues, she recommended checking for toxoplasmosis. She also recommended that any time Saoirse might have a subsequent flare - even a mild one - that prompt instigation of pain management can aid resolve a flare a bit faster because it helps calm the inflammation somewhat.

    Is your vet planning to do another Spec fPL test any time?


    Mogs
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  25. marisofigia

    marisofigia Member

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    No, she hasn't told me that she has any such plans...
    Honestly it's a bit difficult to get vets to do anything. Like I've mentioned, I've seen three and I got pushback from all of them when I tried suggesting anything. The attitude was have you been seeing another doctor/don't you trust my judgement/... etc
     
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  26. tiffmaxee

    tiffmaxee Well-Known Member

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    I see you are in Greece. We have a member from Greeece whose vet is willing to give her meds but unfortunately she was not knowledgeable about diabetes or a lot of other feline issues. Sadly she lost her Naomi last month but perhaps she might know if her vet could help you get have no idea where she’s located and she hasn’t been on the board much. I can get ahold of her to see. Can you give me an idea of a general location where you live?
     
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  27. Critter Mom

    Critter Mom Well-Known Member

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    Maybe back up your questions by sharing info published by recognised veterinary centres of excellence (e.g. TAMU, IDEXX, WSAVA, AAHA, ISFM), veterinary journal articles, etc.? I do that with our main vet at the practice (but I'm ever so slightly blessed that he doesn't object to my being a helicopter pet parent and he's very collaborative in his approach). All you're doing is trying to learn more so that you can do more to help Maya - and that's all to the good.

    Keeping a daily journal of observations helps too because, in addition to being an invaluable aid to spotting patterns and a record of what does/doesn't work to which you can refer back (a huge asset when managing a chronic condition), it gives you a raft of solid evidence to discuss with your vets (and they might begin to take you more seriously).


    Mogs
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  28. Critter Mom

    Critter Mom Well-Known Member

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    PS: The IDEXX pancreatitis document linked above is a great one to wave under a vet's nose when you're trying to negotiate for the right diagnostics and treatments! ;)


    Mogs
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    Last edited: Dec 4, 2020
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  29. Critter Mom

    Critter Mom Well-Known Member

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  30. marisofigia

    marisofigia Member

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    Sure! I am in Athens, Attica.
     
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  31. marisofigia

    marisofigia Member

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    That's good advice! I just need to become a little bit more assertive with these people...
     
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  32. tiffmaxee

    tiffmaxee Well-Known Member

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    I will see where she is.
     
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  33. tiffmaxee

    tiffmaxee Well-Known Member

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    Yanna said to send her a PM. Go to the top and click on the in box. Click start a conversation. For participant put Yanna. I just set her your info to this condo as well.
     
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  34. Critter Mom

    Critter Mom Well-Known Member

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    @CB Terri -

    That web page you linked above has great information. Thanks for sharing it! (Bookmarked.) :)

    @Marisofi -

    From the article previously linked above by Terri:

    Because intestinal parasites may be a factor in any diarrheic state, fecal examinations should be routinely done in all patients.

    That's a professional opinion for you to cite if you ask your vet to check a faecal sample for Maya (just in case the vet might say it's not a good idea).


    Mogs
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  35. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    I just wrap mine in a thin layer of pill pocket like I do for all her bitter tasting meds. Works just as well to when you pill them because it stops the pill from melting before going down
     
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  36. CB Terri

    CB Terri Member

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    It is frustrating and sickening when a person in chatge of your or your beloved pet's health seems unwilling to educate themselves, or keep abreast of the research being done in their field.
     
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  37. kalypso

    kalypso Member

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    Hi Marisofi,
    How is Maya doing?
    If you join facebook IBDKitties group, the person that wrote the epi article on www.ibdkitties.net is a member and may help you.
     
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  38. marisofigia

    marisofigia Member

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    Hi Kalypso! I don't have Facebook, so I can't join.

    I chatted with Yanna though who pointed out that Arden Grange (the dry food recommended to me by a specialized shop where I got the pancreatic enzymes) has been getting some bad reviews for causing diarrhea!

    Today we went from 400 to 150 and back to 400... A roller coaster!
     
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  39. kalypso

    kalypso Member

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    Hi Marisofi!

    Dry food is not recommended for any cat, and especially for one with diabetes or epi. Your cat needs a high quality wet food, high in animal protein and low in carbs. Please read further on nutrition if you like:
    http://www.felinediabetes.com/diet.htm
    https://www.ibdkitties.net/feline-nutrition/
    https://consciouscat.net/2012/03/22/the-best-food-for-your-cat/
    Please do not feed Maya any dry food! And do not take advice on food from pet shops or even vets! Arden grange light doesn't list moisture content, but I calculated %Kals from carbs and it is 46,40 %! That is a huge amount of carbs, it could raise blood glucose significantly and could be the cause for the roller coaster of Mayas values. Please only stick with wellness core, and write me what flavors of it you are feeding her so I can measure carb content for you.

    You could also ask again if you should try lantus, as they have proposed you before.

    I believe it would be of great help to you if you joined the fb ibdkitties group (https://www.facebook.com/groups/IBDKitties/). As you can see, vets knowledge can be restricted on particular issues as the scope of their science is so wide and they are not educated on nutrition. Also, epi is underdiagnosed in cats so it is difficult for them to have enough experience. You need to educate yourself and get all the help you can find, in order to proceed best. You can make a dummy facebook account on Mayas name and even with a dummy email, or you can write a post and I can post it for you!

    How is Maya's appetite and weight? You could add weight measurements and food changes on the remarks column of her spreadsheet so we have a full picture.

    Did you manage to get your vet run a fecal exam?

    @Critter Mom and all could you help me with nutrition and blood glucose levels interpretation and suggestions for Maya or tag someone else you think can help too?
     
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  40. Critter Mom

    Critter Mom Well-Known Member

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    @kalypso -

    Hi Sophia,

    While the ideal approach to treatment of feline diabetes is to safely transition the cat from a wet/dry high carb diet to a low carb wet one, in practice there are some situations where diet choices just aren't that clear cut, no matter how much we might want them to be.

    As I've replied to you before, extra caution is needed when it comes to diet changes for Maya because of her GI problems. Gradual changes are advisable for all cats when moving to a new food with a view to avoiding digestive system upsets, so when a cat already has a GI disturbance much greater care is needed - especially if the kitty is a diabetic receiving insulin. It's critical to minimise the risk of the cat becoming badly nauseated or inappetent - especially if a cat has a history of pancreatitis - in order to avoid disruption to insulin treatment or development of dangerous complications like ketosis/DKA or hepatic lipidosis.

    As a general observation, first and foremost a cat needs to eat. When managing difficult health conditions - especially those affecting the digestive system - one ultimately has to feed what the cat can tolerate, and sometimes it may turn out that the carb value/food type might not be the optimum choice for a diabetic. When managing multiple conditions sometimes it's necessary diet-wise to prioritise a condition other than the diabetes and then work the insulin dosing around the dietary requirements dictated by the other condition.

    @Marisofi -

    If you do want to trial any new food, I recommend that you discuss proposed changes with your vets first because they may have advice on the EPI side of things for you to take into account. Based on my own experience, I'd recommended proceeding with any transition very, very slowly and monitoring very closely for how Maya responds at each stage, e.g. signs of nausea, signs of discomfort after eating (crouching in a tense 'meatloaf' position, hiding, pinched expression on face), worsening of diarrhoea. Word of warning: with pancreatitis in the mix, finding a food that's agreeable can be a slow, fraught process - for both cat and caregiver - with a lot of trial and error involved. Keeping a record of exactly what is fed plus meds and supplements given will be an enormous help to you because sometimes it may be necessary to backtrack to something that worked better for Maya previously. It is my sincere hope that you'll find a food that suits Maya quickly.

    Also, if you do attempt to move Maya to a lower carb diet then you will need to intensively monitor her BG - on both AM and PM cycles - because typically the insulin dose needs to be reduced in tandem with the reduction in carb load. See the feline diabetes page at catinfo.org for more info.


    Mogs
    .
     
    Last edited: Dec 8, 2020
    Reason for edit: Grammar.
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  41. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @kalypso -

    FDMB Vetsulin Guide on managing insulin dose adjustments:

    ------------------------------------------

    Changing the Dose

    Hold the starting dose for at least a week UNLESS

    • your cat won’t eat or you suspect hypoglycemia
    • your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
    After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

    The general guidelines for making dose changes are:
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
    • HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.
    As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], lengthen the waiting time between dose increases. If you decide to change another factor (e.g. diet or other medications), don't increase the insulin dose until the other change is complete but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change.

    Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may race past the right dose for your cat.

    [Emphasis mine]

    Maya has only been on the 3.5IU Vetsulin dose for 5 cycles of the recommended 14 for which each dose should be held (unless a reduction is earned). She has already seen a nadir in the 150s.


    Mogs
    .
     
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  42. kalypso

    kalypso Member

    Joined:
    May 22, 2019
    Thank you Critter Mom for stepping in and for your valuable advice to Marisofi!
    I aggree about cautious food change while on insulin and with diarrhea, Maya was already on a low carb wet food and I was concearned about adding a new dry food.
    But I am afraid I am very skeptical as to any good advice about nutrition coming from vets, at least in Greece :(. For instance, most of them recommend prescription dry for diabetes.
     
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  43. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    @Critter Mom @kalypso many thanks for the inputs.

    I will continue the 3.5 dose for 14 days.

    Maya's appetite has increased significantly the past week, and she is drinking less water.

    My problem with doing away with the dry food is that I have two other cats who have learned to rely on it. I am trying to change their habits but it's taking some time...
     
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  44. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    You'll be able to review the current dose sooner than that, Marisofi. :)

    Just to clarify:

    * 1 cycle = 12 hours.

    * Each day you have an AM and a PM cycle.

    The FDMB Vetsulin guide recommendation is to hold a dose for 7 days (14 cycles) then review and adjust the dose if necessary based on a full curve run on the seventh day plus the daily BG readings taken over the 7-day period. Rinse 'n' repeat.

    Today is your third day on the 3.5IU dose (this evening being the 6th cycle), so you'd continue getting your daily tests in and then run a full curve on Saturday (tests at AMPS, +2, +4, +6, +8, +10, PMPS).

    Given that Maya is seeing nadirs in the 150s on the 3.5IU dose, I'd suggest that if further dose increases are needed going forward that you make any future upward adjustments in 0.25IU increments.

    This is wonderful news, especially that Maya's able to eat better! :cat:

    How are things in the poop department?

    Cats have a way of happening to you while you're busy making other plans.* :rolleyes:

    You'll get there. Here's a link to the catinfo.org tips for transitioning cats to a low carb wet food. It might give you some ideas to try out.


    Mogs

    (* With apologies to Allen Saunders.)

    .
     
    Last edited: Dec 8, 2020
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  45. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Oh ok, now it's clear!

    Poop wise it's getting better. Today was the first time that she had soft stool but not watery diarrhea. Fingers crossed...
     
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  46. kalypso

    kalypso Member

    Joined:
    May 22, 2019
    Very encouraging! Is she on enzymes?
     
  47. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Yes, she's getting WeNzyme and Vivomixx as a probiotic.
     
  48. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    @Critter Mom @Sienne and Gabby (GA) @Aleluia Grugru & Minnie @kalypso @CB Terri @jt and trouble (GA) @Yanna

    Guys, not sure which time zone you're on, it's very late here in Greece. I got up to get some water and something inside told me to measure Maya's BG, call it instinct or whatever. She was at 59!!! I fed her wet food immediately, she ate two and half small cans. She also drank water. Measured again and it was 53. I have no honey at home because I didn't think she would be in risk of hypoing as she's been consistently hitting the 300s-400s... I'll buy first thing in the morning, along with syrup and treats. For now, I'll keep on monitoring. I cannot sleep because I don't know what may happen.
     
    Last edited: Dec 9, 2020
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  49. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    What food did you give her? Was it high carb? What meter are you using, human or pet? If it’s human she’s still in safe range but you do need her number to go up not down. In the future do not feed so much. You want her to be hungry to keep eating so you can bring her numbers up with food. One tablespoon at a time. Do you have high carb food at hand? Do you have your hypo kit?

    Can you test again in 30 minutes after the last test and post please?
     
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  50. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    If it’s pet meter this is a take action number and you need to feed high carb at least to bring her number up
     
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  51. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    I gave her Wellness Core cans, what she usually eats. Not high carb.
    Thank you about the feeding tip.

    I'm using a human meter (Contour next). I tested again after 20 minutes and got 70. Waiting to test again afterwards.

    Edit: 81 after another 20 minutes. Looks better but I will keep on testing.
     
    Last edited: Dec 9, 2020
  52. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    Okay good. Take action number in a human meter is anything below 50. I’d test again in another 30 minutes to make sure she’s staying up.

    you need to have high and medium carb food at hand. Did you read the sticky note about your hypo tool kit? Please read it and make sure you have it all at home
     
    Last edited: Dec 10, 2020
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  53. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
  54. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
  55. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Do you have anything sweet in the house?
    White sugar (can be dissolved in boiling water – helps it dissolve)
    Syrup
    Ice cream (not chocolate and not if your cat is lactose intolerant)
    Icing sugar (it dissolves easily in water)
     
  56. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
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  57. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    Great tips!
     
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  58. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Thank you all. I had bookmarked the pages on hypo but I hadn't prepared a kit because she was almost always way up in the 200s-300s-400s, so I really thought that my number one concern for the time being would be getting her numbers down. I'll go to the supermarket first thing in the morning and get everything needed.

    She is now at 91.
     
  59. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    Great news! I think since she’s on caninsulin the worse is over. I’d test again in an hour if you can. Cats like throwing curve balls at you. Btw, she earned a .25 reduction going under 90 so her nerves dose should be 3.25. She earned it!!
     
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  60. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Will do. And just imagine that my vet has kept insisting that I boost her up to 5, which I have been trying to reach gradually. I think (based on what I've read) that the hypo is also related to the fact that I've changed her wet food from Hill's m/d to Wellness Core that is significantly lower in carbs. Still, she's been getting all these high pre-shot numbers though. Anyway, I will call the vet tomorrow (or rather today, it's 6:30 am here now) to let her know.

    Maya is at 122 now.
    Very thankful for all of your support.

    P.S. It's a bit difficult to calculate 0.25 on the syringe, as there are only markings for 3, 4, 5, etc. So, I have been noting changes of roughly 0.5.
     
    Last edited: Dec 9, 2020
  61. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    You need to get 1/2 unit marked syringes. It’s hard to eye ball in on the unite marks for sure but .5 is too much to increase or decrease by. Btw, we don’t dose by the preshot numbers but by the nadir which is the lowest point in a cycle and the 52 you got today. The food does make a big difference. Happy to help and happy you’re home testing!!
     
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  62. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    Also technically speaking, this was not a hypo. On a human meter, a hypo is under 50 and even then every cat reacts differently. Minnie has gone as low as 47 and acted perfectly fine
     
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  63. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    And one more thing, if this happens again, start a new thread and name it “Help” then the low bg number and the time like @+6 or whenever it is so you can get more eyes on it and more responses. That way members know it’s urgent
     
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  64. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Try using a magnifier or even a pair of cheap reading glasses. A bright light helps as well. Practice with a used syringe and some coloured water. When you have what you believe is the correct amount in the syringe, put it aside and use it as a comparison.
    Some people use calipers. A bit more about them here:
    https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

    A search found these in the UK. Can they be ordered? Are they available in Greece?
    SOL-VET™ U-40 Insulin Syringe With 1/2 Unit Markings

    Unique, high quality latex-free, non-toxic and non-pyrogenic insulin syringe specifically designed for pets.

    1. Half unit markings for more accurate dosing
    2. Optimal needle sharpness and smooth plunger control for more comfortable and accurate injections
    3. Transparent barrel with bold scale markings for easier reading and measuring
    4. Needle bevel is tri-cut for optimal needle sharpness
    5. Flat top rubber stopper minimises residual medication waste
    Tagging some UK and EU members
    @Gill & George
    @Elizabeth and Bertie
    @Critter Mom
    @SashaV

    Caninsulin is not the best insulin for cats. Is your vet willing to switch insulin?
     
  65. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi @Marisofi

    Are you able to get the Sol-Vet half unit U40 syringes linked to in the previous thread? Some of our UK members buy these online. Maybe they're also available online in Greece?

    Alternatively, is it possible to get U100 syringes with half-unit markings? U100 syringes are made for use with U100 insulins (those that have 100 units per ml rather than the 40 units per ml that Caninsulin has). But it is possible to use U100 syringes with U40 insulin in conjunction with a conversion chart to ensure the correct dose is measured.
    http://www.felinediabetes.com/insulin-conversions.htm

    Well done for dealing with that low number situation. It can be very scary the first time we see low numbers... (((Hugs))) :bighug:

    When using Caninsulin the general starting advice is to 'aim' to not have the blood glucose drop below about 90 (5) as measured on a human meter. This is because Caninsulin can often drop the blood glucose quite quickly, and 'aiming' to not let the blood glucose go below about 90 (5) just gives some buffer of safety in case it does actually drop a bit lower than that.

    The often quoted advice on the forum that the 'take action number' is 50 (2.7) refers more to cats on gentler long-lasting insulins such as Lantus and Levemir, as these don't usually drop the blood glucose so fast. The situation is a bit different when using faster acting insulins such as Caninsulin.
    Because Caninsulin can drop the blood glucose fast it is safer not to wait until the blood glucose is below 50 (2.7) before taking any action. Sometimes the blood glucose can drop faster than the caregiver's ability to keep pace with it... So, it is helpful to try to not let the blood glucose drop much below 90.

    With low numbers it's important to bear in mind too that it's not just what the number is, but also, where you see that number in the cycle. This will affect the action that is needed.
    A '90' (or a smidge lower) at the peak of the cycle may be fine, and a nice thing to see. And no action may be needed other than testing again a little later to check that it's not dropping further (the peak of the cycle is not a rigid fixed point...)
    A '90' earlier in the cycle may require some action to stop the blood glucose dropping too fast or too low. If it's close to the expected peak of the cycle it may be that a little low carb snack is sufficient to 'steer' the curve safely past the peak of the cycle. But if there is a long way to go to the peak of the cycle it may be necessary to use medium or even higher carb food to steer the cycle, depending on the situation. If the numbers are dropping really fast then the quickest way to slow or stop that drop is to give a little simple sugar such as glucose, honey, or syrup. What works best varies from cat to cat, but you will learn the kinds of things that work best for your own cat.

    It's a sound idea to put together a little 'hypo kit' that you can grab quickly if you need to.
    A hypo kit absolutely must contain a simple sugar source (glucose, dextrose, honey, or syrup). It's also good to have some higher carb food in gravy (the gravy is the most useful bit) and/or some higher carb liquid treats; some medium carb food; extra test strips; and a spare battery for your meter. ...Sometimes we joke that they should also contain an emergency bar of chocolate - that's for you, haha! :smuggrin:

    Eliz
     
  66. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Thank you! Haven't found these syringes yet but I will keep looking.

    I spoke with the vet today. She is open to changing measuring method to TR but she suggests that we wait another week because Maya has just started taking her pancreatic enzymes and maybe they had an effect on the rapid change in BG.
     
  67. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Many thanks Eliz! I guess it was bad.. And to think that she was sound asleep, if I hadn't measured her BG, I would have had no idea...

    I'm getting my hypo kit ready today (chocolate bar for me included ).
     
  68. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    A thought:

    My civvie, Lúnasa (aka The Noodle), has a very sensitive digestive system. She actually had an episode of acute pancreatitis a couple of years ago following a protracted period of GI disturbance when she was hyperthyroid. I tried her on umpteen wet foods but to no avail: they all triggered digestive upsets.

    Our vet recommended Virbac Digestive Support veterinary diet for her, partly because other of his patients with similar issues had done well on it but also because, as dry foods go, it's not insanely high in carbs (16% kcals from carbs). Given that Lúnasa had already been diagnosed with early stage renal insufficiency I'd have far preferred her to be on a wet food - but she has to eat so reluctantly I gave it a go.

    Lúnasa did really well on the GI support diet. She was on it for years. The Noodle's now at IRIS CKD stage III and I recently had to switch her to the renal support diet from the same range (closest ingredient match I could find) but she stopped eating enough and eventually refused it completely. I switched back to a mix of the CKD and GI support kibbles and thankfully she's eating again. She's also starting to poop more regularly again and seems more comfortable overall. Again, not ideal, but she'd get nowhere if she didn't eat anything.

    I am wondering whether, given you need to feed a mix of wet and dry food at the moment, the Virbac GI kibble might be a food to consider for your little ones (assuming it's available where you are).

    Virbac Digestive Support Veterinary Dry Diet
    --------------------------------------------------------------

    Ingredients:

    Pork and poultry dehydrated protein*, potato starch, animal fat*, whole pea, mineral salts, pork and poultry hydrolysed protein, beet pulp, lignocellulose, linseed, fish oil*, psyllium fibre, fructo-oligosaccharides, chitosan, yeast nucleotides, yeast beta glucan, butyrate salts, pasteurised Lactobacillus acidophilus.

    *highly digestible ingredients

    As fed analysis:

    * Protein - 44%
    * Fat - 21%
    * Crude Fibre - 3.5%
    * Crude Ash - 8.5%
    * Moisture - 4.9%

    Carb Content (calculated):

    * As fed: 18.1%

    * Dry matter basis: 19.0%

    * kcal from carbs: 16.0% <<< This is the value we're interested in when choosing a food for a feline diabetic.

    I'm glad to read that Maya's eating better and her BMs are starting to improve in consistency.


    Mogs
    .
     
    Last edited: Dec 10, 2020
    Reason for edit: Formatting.
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  69. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Well done catching the low last night, Marisofi.

    Given you've dropped the carb load in Maya's diet, I'm glad to see that this morning you reduced the dose back down to 3.5IU. (Note: Depending on Maya's response it may be necessary to reduce further, and soon.)

    I fully understand how very much you want to see Maya in a better overall BG range - we all feel that way - but regulation is a gradual process that requires much patience on our part.

    I very much recommend that you hold the 3.5IU dose for the time recommended in the Vetsulin guide.

    It would benefit you from a safety perspective and also in determining dose efficacy to get a few more mid-cycle tests each day (as best your situation will allow).

    A +2 test would help you to catch fast drops and, if necessary, intervene early with a low carb mini feed to help slow the drop. It also would give you an idea of where the cycle might be headed.

    The guts of the drop should be measurable by +3 BUT BG levels could still go lower in the following hours (typically between +4 and +7 but it's possible for nadir to occur later, particularly if the dose is too high).

    Tests between +6 and +12 typically throw light on the duration of the dose. Numbers climb significantly when the Vetsulin dose peters out - usually several hours before the next dose is due.

    Of all the tests, the ones likely to catch fast drops early and the cycle nadirs are the most valuable.


    Mogs
    .
     
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  70. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    I don’t think you can follow TR on caninsulin and I’d be very nervous about it with such a fast acting harsh insulin @Red & Rover (GA) and @Elizabeth and Bertie and @Critter Mom thoughts?
     
  71. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Not that I'm aware of. There is a modified TR protocol for Prozinc now.

    TR protocol using caninsulin makes me nervous as well.

    Changing the Dose
    Hold the starting dose for at least a week UNLESS​
      • your cat won’t eat or you suspect hypoglycemia
      • your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
    After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
    The general guidelines for making dose changes are:
      • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
      • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
      • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
      • HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.
    As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], lengthen the waiting time between dose increases. If you decide to change another factor (e.g. diet or other medications), don't increase the insulin dose until the other change is complete but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change.
    Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may race past the right dose for your cat.​
     
  72. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @Aleluia Grugru & Minnie -

    As Red observes above, TR is a protocol for cats on Lantus/Basaglar and Levemir, not Vetsulin/Caninsulin.

    When cats start getting lower nadirs on Vetsulin/Caninsulin it becomes increasingly difficult to administer safely because it typically produces such big drops. Also curves are typically bucket-shaped. A cat can go from a fairly high preshot level down to potentially dangerous nadirs, even on a tiny dose.

    As cats become better regulated on the depot insulins, curves become more like shallow smiles. This usually means that tightly regulated cats treated with those insulins can be dosed at lower preshot levels, leading to the cat staying fairly flat right through each cycle (with the required amount of testing to keep the cat safe), often referred to in the support group as "shoot low to stay low".

    If Marisofi were to wish to aim for Maya to be tightly regulated, a different insulin would be needed.


    Mogs
    .
     
  73. CB Terri

    CB Terri Member

    Joined:
    Nov 9, 2020
    Hi Mari sofi - my cat Sootie has been on bovine pancreas the past 8 days or so. Yesterday he had first semi-solid poop in months and today it was SOLID. Ihad to up what I was giving him and that may still need playing. At first I was giving only 1/4 tsp per day like sprinkling salt on my supper. Now I am using a little more than 3/4ths of that 1 quarter teaspon with 3/ can of Fancy Feast Trout flakes.
    I also give him a 1/tsp slippery elm with each meal, and a sprinkle of forta flora probiotics. He is also receiving 5 mg prednisone. None of our vets has been willing to get him in to see him nor do I honestly believe they even could have diagnosed him. They do not even carry prednisolone, only prednisone - fortunately I take prednisone for my kidnry transplant. So I have been sharing mine. Today he also had a sliver of acetaminophen (10mg i believe) which may be repeated in another 72 hours if he starts grinding his teeth again.
    And now for why I visited the forum tonight - my other diabetic cat cotton had a 2.9/52 tonight at his 8:00 pmps so I am going to post about that. I fed him a gravy fancy feast, some dry quail kibble and a tsp of sugar syrup and got a 5.9 20 minutes after. I am stalling on his Lantus to see if numbers continue to rise - I know 2.9 isn't considered hypo but it surely puzzles me as I've never seen it so low - but a great number really!
    Good luck with your baby, and from me to you, consider switching to lantus just to not get the horrible low nadirs and sudden jumps.
     
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  74. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Τhank you so much for sharing Terri! Looks like Sootie is a fighter, and so are you! Maya has never had raw meat in her life. She's been having a tough time letting dry food go, so I'll try to introduce changes slowly...

    I actually took Maya to the vet today, so that she could have her B12 shot. We discussed changing to Lantus but the vet said that I should give her some time on Caninsuline first because she hasn't been on it for that long, and we have already messed with the dosage one too many times this month. Not sure if I could move to Lantus without her recommendation because I guess I would have to come up with the right dosaging all by myself...

    I'm reading what I write and it reads as if I'm operating from the standpoint of fear because, well, I am! I guess we'll go for Caninsulin until the end of the month and monitor how it goes. As for the raw pancreas, I'll try to get her to try some for Christmas, let's see the reaction!
     
  75. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    I understand it’s scary to go off of what your vet is recommending. Like taking the training wheels off but we’ll be here to help you. You start on 1 unit of Lantus and go from there. Sometimes vets need to be told what we want to do and not the other way around. I found every time I’ve been firm with a vet about what I want to do for my cat’s treatment they’ve seen I was resolved and agreed. It’s all in how you say it and present it to them. Not, do you think we should? But I’ve decided I want to do this. My two cents. Caninsulin is not a great insulin for cats. It was made for dogs hence the name canine. Dogs have a slower metabolism than cats. Those are the facts. Staying with it longer is only detrimental to your cat’s health. Be firm my friend. There are studies that prove this and I know someone here has a link @Panic @tiffmaxee
    I’m saying this from experience. I spent months listening to my vet and Minnie kept getting worse. She developed severe neuropathy and couldn’t jump or go in or out of the litter box. It took that to make me wake up and stop listening and start taking control of her treatment. I hate to see anyone else have to go through the same :(
     
  76. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    I hear you. I've read up on Caninsulin and everyone is
    Wow... Ok I hear you. I see the vet every week for the B12 shot. Next week I'll go to her and firmly ask to make the transition. If she still refuses, I'll come back to you guys for help on figuring this out by myself.
     
  77. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
  78. CB Terri

    CB Terri Member

    Joined:
    Nov 9, 2020
    I am using the powdered pancreas, it is freeze-dried, easy to use, keeps very well, and available online. I also got it at a local petvalu store while waiting for the stuff I mail-ordered.
    I do not blame you for being cautious and fearful one bit - you can only work at the pace you are comfortable with, and you are dealing with issues with one cat that I am dealing with in two - so not so much for me to try and figure and balance as you ❤
    With the Lantus I started at the same dose as I was at for Caninsulin, which for my cat was 2 units 2x a day. If or when you make a switch to Lantus you will find dosing help here at the forum.
    But I remember "SLGS" - Start Low Go Slow. Starting with a small dose gives you time to see how your cat adjusts to it, and to increase in small amounts to see how it affects your cat without going too far.
     
  79. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    To strengthen an argument to move to another insulin, the best thing to do is show the vet data. I'd suggest over a period of a couple of weeks get tests - as religiously as you can manage - around the nadir mark and also later in the cycle when the dose peters out (round about the +7-8ish mark for Maya as best I can see based on current data) then you can prove to your vet that the Caninsulin has insufficient duration.

    It's my understanding that cats who start treatment with longer-acting insulins within 6 months of diagnosis have a better statistical chance of achieving remission.

    With regard to 'going off piste' with insulin treatment, it's not a course I'd recommend. There's more to managing a diabetic than taking control of the insulin side of things. Diabetes is a chronic, multifaceted condition and cats need to be under the care of a vet in case any complications arise, especially in an emergency (e.g. severe hypo, ketosis/DKA). I think it's better to negotiate hard with the vet to prescribe a better insulin - armed with data and documentation from sources a vet would consider reputable to back up arguments - or perhaps go shopping for another vet who is more willing to work as a partner with you in Maya's care.


    Mogs
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  80. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    That’s what I was thinking of, thank you! I’m bookmarking it now :bighug:
     
  81. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Hello friends!

    Yesterday I saw the vet and explained why I would prefer to transition Maya to Lantus. Her reply was that Lantus is indeed a great option but that it would be best to try it after Maya has completed a couple of months on Caninsulin, for two reasons:
    1. Maya seems to react well to Caninsulun
    2. If Maya does not react well to Lantus, we won't be able to switch back to Caninsulin
    Opinions?

    We also weighed Maya and she has gained 300 gr :):):)
     
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  82. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Maya may react even better to Lantus. All going well, on an appropriate dose she should end up with much flatter curves in a narrower, better overall range. This in turn should enhance chance of remission.

    With Maya's current Caninsulin dose, she's spending part of the day well above the renal threshold (a classic Caninsulin 'bucket shape' curve). I don't think that you'll have much play in the way of increasing the dose: she's already had nadirs below close to or below 100 on the 3.5IU dose and the 4.0IU dose took her too low for safety.

    My understanding is that cats who start treatment within the first six months post-diagnosis with a long-acting insulin (Lantus/Basaglar, Levemir, Prozinc) have a greater statistical chance of achieving remission.

    What reason did she give for this claim?

    Also, Prozinc or Levemir would be better insulins to try if Lantus were not to suit Maya.

    Attagirl, Maya! :cat:

    How is her digestive system now, Marisofi? Is the vet going to run a follow-up TLI test?


    Mogs
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  83. kalypso

    kalypso Member

    Joined:
    May 22, 2019
    I thought she had told you to only stay on caninsulin until the end of the month.
    Even if it were true that you can't switch back to caninsulin, what difference would it make 6 months later? It doesn't make sense.
    Is this the same vet that wanted you to start on 5u caninsulin right away?
     
  84. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    I think everyone already expressed my concerns. For some reason your vet is stuck on caninsulin and it may be that it’s because it’s all she knows. If it were me, I’d either insist on what’s best for my cat or id look for another vet. We’ve already supplied you with all the ammunition you should need to prove your point. Did you read the link Panic posted? As Panic said on 12/12 “The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats is what you should print out and give your vet. Highlight the parts where it recommends only Prozinc and Lantus/Levemir for felines. Caninsulin is only listed in the canine section.”

    https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

    the best shot at remission is getting your cat regulated within 6 months. You don’t want to waste precious time with an insulin made for dogs who have a much slower metabolism than cats
     
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  85. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    She didn't give any further reason.
    She also did not suggest another TLI.
    Maya is easing more and having diarrhea less often. Her stool is never completely solid though.
     
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  86. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    No that's not the same vet. She had suggested I started with 2,5.
     
  87. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    I see, yes.
    So do you know of any guiding note that I can use to see how I can transition her to Lantus by myself. Meaning, how many units of Caninsulin translate to how many units of Lantus.
     
  88. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

    Joined:
    Dec 21, 2019
    I think the overall consensus here is to start with the same dose. So if she’s on 2 units of caninsulin, you’d start her on 2 units of Lantus. But you need a vet to give you a prescription for any insulin
     
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  89. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Thank you. Which means that 3.5 in Caninsulin equal 3.5 in Lantus.
    I may be able to get it without a prescription, I'll give it a try.
     
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  90. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    Since you are using Caninsulin, that means you are not in USA otherwise you wouod be using Vetsulin. If you are in Canada you can just go to local pharmacy at get insulion w/o script.
     
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  91. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    For future reference, Larry, Marisofi is in Greece.


    Mogs
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  92. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Hi Marisofi!

    In Greece you don't need a prescription for Lantus.
    I have 3 unopened vials which I no longer need. I live in Evia - Halkida. I would be happy for you to have them. If distance is an issue for you and you know anyone around my area using Lantus please let me know
     
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  93. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    That's right, thank you for chipping in Mogs!
     
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  94. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    That's so nice, thank you Tanna! I'll send you a PM. We're about to finish the last Caninsulin vial, so I figured we'd change after that.
     
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  95. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Marisofi,

    I just had a look at Maya's spreadsheet. I see you got a 46 on the evening cycle of 26 December. That means the 3.5IU dose is too high (50 is the lower bound of the normal feline BG reference range as measured on a human meter). According to the FDMB Caninsulin guidelines, the dose should be reduced by 0.25IU immediately.

    For future reference, the FDMB Caninsulin guide recommends reducing the dose by 0.25IU if BG goes below 90 (human meter). If you look back a couple of days on the spreadsheet, Maya dipped to 86 on the morning cycle of 15 December and down to 70 on the morning cycle of 22 December, both readings signalling that the 3.5IU dose needed to be reduced - ideally on the PM cycle of 15 December. The 26 December 46 reading confirms the 3.5IU is too high.

    If ever you're not sure whether a dose needs adjustment you can always post for feedback on Maya's BG data.


    Mogs
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  96. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    I just read that auto-correct wrote you down as "Tanna"
     
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  97. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    Many thanks Mogs!
    I saw your message and I've been administering 3.25 over the past 3 days. Today I took Maya to the vet for her Articlox shot (this is supposed to go on for a total of 6 weeks by the way) and we both came to an agreement that Maya will transition to Lantus after the holidays i.e. next week

    Also, check out her weight! When I first joined the forum a month ago, she weighed 3 kilos.
     
  98. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    She's put on nearly a kilo!!! :woot: That's brilliant. :cat:

    Really pleased you've finally got buy-in from your vet for the Lantus. Wishing you both the very best for the coming year. :)

    (((Marisofi and Maya)))


    Mogs
    .
     
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  99. marisofigia

    marisofigia Member

    Joined:
    Nov 25, 2020
    I mean it when I say that I don't think I could have gotten her on track if it hadn't been for this forum! Thanks to @kalypso for recommending that I join, to you Mogs for always being present with a helpful piece of advice, and to all the other members who have pitched in to support Maya and I! Of course our work is far from over, it will never be over, but at least now it really feels like we have a fighting chance!

    Happy New Year all!
     
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