Hi Brandy and welcome to you and your kitty.
I'm sorry to hear she has been feeling so poorly.
She had something looking suspicious around her pancreas area but they think it may be inflamed due to the diabetes.
When I read your opening post the first thing that came to my mind was pancreatitis, and I see Linda also thinks similarly. The high blood sugars may be due to pancreatic inflammation. I note that your kitty had appetite problems a year ago. Some cats do experience low-grade chronic pancreatitis and symptoms can wax and wane. I am wondering whether the previous episode of inappetence could possibly be related to her current difficulties?
* Has your kitty ever experienced a fall or other accident?
* Did you get a new batch of her regular food recently?
* Has she been showing any signs of nausea?
Nausea and appetite problems - symptom checker
If nausea is an issue then appetite stimulants won't work until the nausea is resolved. For general nausea and appetite stimulation ondansetron and cyproheptadine can work well in combination. (Note: there is a potential adverse drug reaction between ondansetron and mirtazapine (another commonly-prescribed appetite stimulant); when used together they can increase the risk of inducing serotonin syndrome (a potentially life-threatening condition). Cerenia is another anti-nausea treatment. It may start to work quicker than ondansetron (see IDEXX guidelines below for more info).
I note from your opening post that your kitty had some diarrhoea along with a normal stool. Was the normal stool hard/large? Sometimes when a cat is constipated it can induce nausea. Also sometimes liquid faeces may leak around a stool that's 'stuck'. In addition a constipated cat may vomit (especially when trying to pass a 'stuck' stool). It is advisable to check whether your kitty might possibly have constipation-related nausea. Note that it is unlikely that ondansetron or Cerenia will help much if constipation is causing the nausea. Treating with metoclopramide for 1 or 2 days can help improve gut motility and possibly resolve constipation-related nausea. Useful information on constipation can be found here:
www.felineconstipation.org
Follow-up treatment with another nausea med may be needed for a while. If nausea is a problem then quite often appetite will return when anti-nausea treatments are given. If not, an appetite stimulant may help. Cyproheptadine is gentler in action and shorter-acting than mirtazapine (8-12 hours vs. 2-3 days) so it gives better control over how much or how little appetite stimulation is given. It's also less likely to produce unpleasant side effects.
her vet is pushing hills.
Yep! The Hill's prescription diets for diabetes (m/d and w/d - wet and dry) are too high in carbs for a diabetic. w/d has so many carbs it's like kitty cornflakes.
Purina DM canned prescription food is under 10% calories from carbs (the recommended limit for feline diabetics) but a low carb commercial food is just as good, if not better. Here's a link to the feline diabetes page on a very well-respected, vet-authored site about feline nutrition for your information:
http://catinfo.org/feline-diabetes/
If it is pancreatitis then here is an extremely helpful resource covering diagnosis and treatments:
IDEXX pancreatitis treatment guidelines
If pancreatitis is present then management of nausea and pain (if present), good hydration and feeding small meals can help resolve a flare faster. Behaviours following ingestion of a meal such as crouching in a tense meatloaf position, withdrawing or hiding, or seeking out cool surfaces to lie on (e.g. stone/tiled floors) may point to the kitty experiencing pain. Treatment with buprenorphine for pain relief may help to resolve a flare more quickly.
Please let us know how you get on with the vets and what the test results show tomorrow.
Hoping your little one feels much better very, very soon.
Mogs
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