Newly diagnosed diabetes + chronic pancreatitis

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samesque

Member Since 2017
My Krillin (14 years old) was just diagnosed today with diabetes. He's had chronic pancreatitis for years and has been on prednisalone often to keep it in check. Now he has to have a daily maintenance dose of pred to keep his pancreatitis at bay - if I try to ween him off, it just comes back.

So now as I understand this is a complicated situation, because of the need for the pred and the insulin. Does anyone have experience with having a cat on pred and insulin?

Also, I just gave him his first dose and am watching him. Is there anything I should look for in case he goes hypo? How long does it take for him to go hypo if that's going to happen? Is it soon after injection or hours later since its subq?

I'd love to hear any tips or experiences, especially with the pred and insulin combo.
 
Welcome. Different insulin work at different rates and intensities. What is your cat taking?
Vetsulin tends to hit relatively quickly with the lowest point between 4-6 hours. ProZinc around 6-8 hours....

The best way to keep them safe is to home test. We can walk you through that if you are willing. Cats insulin needs change. One day the dose is good, the next it could be too much, or not enough.

Most of us on here test and share our numbers in the dorm of a Google Sheets spreadsheet like the one you see in my signature below.
 
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He is on ProZinc.

I would like to home test, but my vet didn't offer it as an immediate option, he actually said something about testing being a "down the road" thing.

I think my cat would allow me to test. He seems generally OK with the poking and prodding.

Is there a way to get home tests without having to go through the vet? Or do I need to talk to my vet again?
 
samesque said:
He is on ProZinc.

I would like to home test, but my vet didn't offer it as an immediate option, he actually said something about testing being a "down the road" thing.

I think my cat would allow me to test. He seems generally OK with the poking and prodding.

Is there a way to get home tests without having to go through the vet? Or do I need to talk to my vet again?
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you don't need your vets approval to test. I think most vets don't want to over load the recently diagnosed caretakers with too much for fear they will become overwhelmed and opt for putting the pet down, ya know?


You can get a pet meter such as the Alphatrak 2 which is what you're very most likely uses, or you can get a human meter. Alpha would be calibrated for feline blood so the numbers would be the same as at the vets. The downside is the strips are expensive at about a dollar each. Most people on this forum opt for the less expensive human meters. (The Walmart Relion Micro is popular). Human meters will read lower than the Alphatrak, but will still be able to tell you if your cats bg is too high or too low, and at a much less expensive cost... About a third the cost. If you choose a different brand meter just choose one that requires a very small sample.
You will also want to get 28 gauge lancets to poke. The 30 guage ones are too small and it makes it hard to get a drop. (The bigger the number, the smaller the needle).
You just poke the ear in the sweet spot, and touch it to the test strip in the meter.
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Hi--

Yes, as Janet says, you can definitely test at home without having to go through the vet. The pet meters are awesome (and "speak the same language" as your vet's meters, but have a big cost downside. Most people on this site get along with a human meter (such as the ReliOns)-- you don't get the total accuracy, but the really important thing usually is the relative number (bigger/smaller than the last number), so it works out. Factors to consider when buying a meter: cost of strips (it really adds up), and the convenience of obtaining strips (online is great if you are good at planning ahead, but one of the reasons ReliOns are so popular is that Walmarts are open a lot, including those inconvenient times when our kitties decide to go low!).

The instructions for setting up the spreadsheet Janet mentioned are here. It's really a great tool for managing FD.

You also asked about managing pred and diabetes simultaneously. I don't have personal experience with that, but my understanding from other people here is that, when there's another major health issue on board, that takes priority and the diabetes and insulin needs are structured around that.
 
Ack, now I am disappointed I didn't explore the testing options more thoroughly when I was at the vet. I already gave him his first dose and can't help myself watching him like a hawk.

He had a rough day of a 14 hour fast, car ride, vet visit, ultrasound (for pancreatitis), blood glucose test, more car ride, then his tummy probably bothered him when he had his first meal, then he got an injection. He was already stressed and unhappy, so now it's hard to tell if his quietness, solitude and sullenness are due to his stressful day or the injection. But it takes time for the insulin to be absorbed? If he had problems, it could happen after I'm already in bed :(

I think I'm going to try to get a test kit tomorrow. I'm not afraid of testing or doing stuff for him. He is a lymphoma survivor (9 years remission - by human terms he is considered cured). I want to do this right, i don't want to put him in danger of crashing. The pred can cause insulin resistance, so hoping he will at least be ok tonight until I can get better prepared.
 
samesque said:
Ack, now I am disappointed I didn't explore the testing options more thoroughly when I was at the vet. I already gave him his first dose and can't help myself watching him like a hawk.

He had a rough day of a 14 hour fast, car ride, vet visit, ultrasound (for pancreatitis), blood glucose test, more car ride, then his tummy probably bothered him when he had his first meal, then he got an injection. He was already stressed and unhappy, so now it's hard to tell if his quietness, solitude and sullenness are due to his stressful day or the injection. But it takes time for the insulin to be absorbed? If he had problems, it could happen after I'm already in bed :(

I think I'm going to try to get a test kit tomorrow. I'm not afraid of testing or doing stuff for him. He is a lymphoma survivor (9 years remission - by human terms he is considered cured). I want to do this right, i don't want to put him in danger of crashing. The pred can cause insulin resistance, so hoping he will at least be ok tonight until I can get better prepared.
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Testing really does put your mind at ease. I wish I had started it sooner than I did. I waited 6 weeks.

What's your dose? What was the number at diagnosis?
 
samesque said:
I already gave him his first dose and can't help myself watching him like a hawk.
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I was the same way when I started and wasn't testing Maury. I am guilty of it, again, now because he's numbers are getting better :cat:. If he is doing good, I have to force myself to do something so I'm not staring at him lol.

I did purchase AlphaTrak 2 starter kit but like some have said the strips are a bit $$, even with the alternative Free Style Lite test strips. So a couple days ago I bought a ReliOn Confirm from Walmart. Like some others, I will use the AT2 for curves for the Vet.:)

As JanetNJ said, ProZinc usually has the lowest numbers around the mid-cycle. The Spreadsheets (SS) a lot of us use is super helpful so others can look at Krillin's numbers as well as setting up your Signature so you're not constantly asked, what insulin, what dose, what food, etc. :cat:
 
Because of the pancreatitis issue, I'm trying to encourage him to eat the hills science diet "digestive care" prescription food. Its gentler on his tummy.
 
samesque said:
Because of the pancreatitis issue, I'm trying to encourage him to eat the hills science diet "digestive care" prescription food. Its gentler on his tummy.
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Is that the hills I/d food? Is it dry? I believe that one is 30% carbs. Ideally diabetic cats should eat food less than 10%. (Most of us feed fancy feast classic or Friskies pate). If it's the only thing that won't upset his belly you'll have to go with it.
 
Yes, I/d. Dry and wet - mostly the wet right now. How can you find the carb content? The side of the can only said fat and protein.
 
Yeah, I am not ever going to give him another insulin injection without testing first.

He had some mild-moderate hypo symptoms about 5 hours after injection, even at that low of a dose (thanks to whoever shared that link), and it was compounded by diarrhea from his pancreatitis. Food and honey water helped, but as I was sitting awake with him to make sure he was ok, I did some research and I'm wondering if the vet properly diagnosed/dosed him? He did have glucose levels of 300+ for the last week, but they never did a urine test. They never did the fruct test. On top of that, the pancreatitis can cause blood sugar spikes, and it inhibits his ability to properly Digest and uptake nutrients from his food. I don't think he had enough food in his system after breaking the 14 hour fast.

Tonight was nerve-racking and worrying, but I think he's okay now. I was thisclose to driving 20 miles to the emergency vet before he turned the corner. I'm getting a tester kit today and I'm going to start taking readings. I am not doing this again completely blind.
 
samesque said:
Yeah, I am not ever going to give him another insulin injection without testing first.

He had some mild-moderate hypo symptoms about 5 hours after injection, even at that low of a dose (thanks to whoever shared that link), and it was compounded by diarrhea from his pancreatitis. Food and honey water helped, but as I was sitting awake with him to make sure he was ok, I did some research and I'm wondering if the vet properly diagnosed/dosed him? He did have glucose levels of 300+ for the last week, but they never did a urine test. They never did the fruct test. On top of that, the pancreatitis can cause blood sugar spikes, and it inhibits his ability to properly Digest and uptake nutrients from his food. I don't think he had enough food in his system after breaking the 14 hour fast.

Tonight was nerve-racking and worrying, but I think he's okay now. I was thisclose to driving 20 miles to the emergency vet before he turned the corner. I'm getting a tester kit today and I'm going to start taking readings. I am not doing this again completely blind.
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I think that's a great plan. The pancratitis can definitely spike numbers, as can stress of being at the vet. Most likely the numbers are elevated but probably lower than originally thought. Testing at home is the only way to know. Glad you caught that recent hypo and we're able to keep him safe.

Don't give one unit again. When you test don't shoot if it's under 200 just to be safe... At least until you have more data. And if only do a half unit. You can post on the ProZinc forum to get additional advice from more experienced ProZinc users.

To set up a sharable spreadsheet with us, download Google Sheets and go here for the template. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
It has been 10 hours since the injection - is the likelihood of another bout of hypoglycemia possible or unlikely at this point?
 
samesque said:
It has been 10 hours since the injection - is the likelihood of another bout of hypoglycemia possible or unlikely at this point?
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ProZinc is an in and out insulin, meaning it doesn't build up in the system and make a deposit like lantus. It usually wears off 10-12 hours after injection so another hypo at this point is unlikely.
 
At the vet, waiting for fluids, a vitamin shot and a glucose test. He looks better than he did last night but not by much. He's talking more.

He was doing so well yesterday with his pancreatitis and gaining weight. Now I feel so bad. I did what I believed I was supposed to do, with the info that I had, and now he's hurting. I am beside myself.
 
Just read this-- I'm so sorry you had such a rough night! Don't beat yourself up for this-- you only did what the vet recommended, and you went above and beyond by doing additional research. That meant you were ready and watching for signs last night, and ready to act when you saw evidence of a hypo. If you hadn't been watching and knowing what to do, the outcome could have been much worse. :bighug::bighug::bighug:

Glad you are at the vet now, getting him checked out and getting him the care he needs. I definitely agree with getting started on hometesting before doing any more insulin shots, regardless of the glucose number you get today-- not only will vet stress raise BG numbers, but if he did go very low last night, there's often a counter-reaction in a cat's body that will raise BG numbers (sometimes by hundreds of points) for a couple days afterwards. Get him home, catch your breath, do some testing-- and post again over on Feline Health or in the ProZinc forum for questions and tips!
 
At the emergency vet. He is not doing well :( I am scared. He was doing so well yesterday before I gave him his shot. Now I feel like he's going to die.
 
Oh, poor little guy.... BG that high can make them feel pretty yucky, but it's very good he's at the vet now so that they can check for other things going on and address them.

I hope they can figure things out, and get him feeling better very soon.
 
Thanks. It was hard to leave him there, but they are keeping him overnight. Prayers and good thoughts, please.
 
samesque said:
Vet just callex, he is so anemic he needs a blood transfusion :/
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Oh no! I just got caught up on your story.

I've been down this road with one of my boys. The transfusion should make him feel way better, and it will buy the vets some time to try to figure out the underlying cause.

I'll be thinking of you both. :bighug:

Sandi&Whisper.
 
What was ultimately wrong with your kitty? What was the outcome?

I'm on my way to bed, called the vet to see how he is doing. He just finished hour 1 of his transfusion, with 2 more to go. I didn't realize they take so long!
 
samesque said:
What was ultimately wrong with your kitty? What was the outcome?
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Honestly we never really found out the cause of the anemia. We were all suspicious that it was a side effect of the Methimazole that he had recently started taking for his thyroid. After the blood transfusion he got stronger, we added erythropoietin to promote blood cell formation, and we dropped the Methimazole (aka Tapazole). So we don't know for sure what it was, but he was then in great shape for over a year before he passed of different issues.

Hoping for the best for you and Krillin. Let us know how you are both doing.

Sandi.
 
How long did it take after the transfusion for him to get stronger? He got it last night and he's still been weak, but the tech who is watching over him said he is getting more alert and watching more of what is happening around him.
 
samesque said:
How long did it take after the transfusion for him to get stronger? He got it last night and he's still been weak, but the tech who is watching over him said he is getting more alert and watching more of what is happening around him.
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I honestly don't remember exactly, it was 4 years ago, but I know that it was not immediate because we came home from the ER and went back and forth to our regular vet for weeks making sure his PCV count got up and stayed up. But I think that it really depends as much or more on the underlying cause too. Give it time and don't lose hope.
 
I might have to put him to sleep tomorrow because they can't figure out what's wrong with him. I asked them if they thought it was the insulin that I gave him, and they said that they weren't sure about that, but that they don't think what's happening to him as a result of JUST insulin. They also said that 7 to 10% of cats diagnosed with diabetes just don't do well with any sort of insulin and there's no other way to manage their condition outside of a clinical setting. They think it's possible a bad reaction to the insulin did set off complications of underlying conditions. But they still don't even know exactly what those conditions are - they don't know why he was anemic, they're even doubting whether he had pancreatitis or if it was something else. His critical care cost estimate goes through Monday morning, at which point I have to figure out what to do next. They said that even if he starts turning a corner, he would need to be at the vet for another 48 hours or more to give him his best chance. My CareCredit card will be maxed after this, and I don't think I have enough space on my other credit cards to swing much more. Plus if they don't even know what is wrong with him, there's no way to know if he can get better.

I don't know what to do :'( :'( I am bawling my eyes out. I have saved his life twice and I don't think it's going to happen again. I'm totally losing hope. I think about how he was on Friday before the injection and how he is today, and I still can't believe this is happening.
 
I've thought about taking him home and trying to take care of him, but if he is in the condition that he is in with round-the-clock Professional Care, I just don't know that bringing him home is going to make a difference.
 
Oh wow... I don't even know what to say. I don't understand what is going on here. I obviously can't make real judgements about Krillin's condition from this distance, but I will make a couple points: I've never heard of this 7-10% of diabetic cats being untreatable statistic, and I think it's very strange that these vets (not your usual vet, right?) are casting doubt on a pancreatitis diagnosis of years-long duration. There are tests for pancreatitis, both to determine whether or not it is present and the severity-- it's a difficult disease to manage, but not all that mysterious to diagnose once it is suspected. Basically, what I am saying is that I'm not 100% on board with these ER vets from what you've said-- I have no idea whether they are on the ball in general with Krillin's treatment, but if it were me... is there anywhere you could take him for a second opinion tomorrow?

So sorry things have taken this turn. You have done everything right, and there's no reason why this should be happening. I'm just hoping for a good outcome. :bighug::bighug::bighug::bighug::bighug:
 
Yes, he is being transferred to the care of Blue Pearl specialists tomorrow and they are going to look at what tests have been performed, do another physical evaluation and talk to me about options moving forward. If their suggestions are invasive, I don't think that I could go through with them for Krillin, he has already been through so much.

Even if they are doubting the pancreatitis, they are still administering the typical treatment for pancreatitis - fluids, anti-inflammatory medication, vitamins and pain relief. But from what I understand food is one of the things that is needed to help cats recover from pancreatitis, and he hasn't shown interest in food. Since it's been about 24 hours, I've asked them to consider syringe feeding him, and they've also talked about giving him a tube for food. I don't like the idea of him having a tube. :/

Depending on how tomorrow goes, part of me is considering trying to scrounge up the money to get him to stay another day, part of me is worrying about having to put him to sleep, and part of me is fantasizing about bringing him home to try to care for him. But I don't know how feasible that last option is considering what happened the last time I gave him insulin.

I'm not ready to let go, but I don't want him to suffer. I want to give him his best chance to pull through. I feel like it would be much easier to make a decision if they could tell me exactly what is wrong with him. Then I would feel like I could confidently make a real decision with his best interest in mind. But without knowing what is wrong, I don't know how to make a decision that is good for him.
 
Slight glimmer of hope: His BP is now in the normal range, his glucose is holding steady, they syringe fed him like I asked, and he's getting feisty with the techs when they try to take his vitals.

Bonus: One of the Vets on staff at Blue Pearl tomorrow is/was a big wig at the University of Minnesota veterinary hospital.

Crossing all my fingers and toes. Any additional positive vibes, prayers, healing energies, lit candles, voodoo, hoodoo, Care Bear Stares and Cousin Calls - anything you got, I would greatly appreciate.
 

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Sending prayers, healing vines, and keeping all fingers, toes and paws crossed for sweet Krillin!
 
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