? 10/4 Primball | first post :)

[primball]

Hello! My name is Tiffany and my cat's name is Primrose (but her name is also Meatball... hence Primball). I've been lurking on these forums for awhile, and have learned a lot from it already! Our vet recently referred us to an internal medicine specialist, and we have an appointment in a couple weeks, but I wanted to also get some other opinions on our situation. Thanks for reading

Prim was first diagnosed with diabetes last year, but quickly went into remission by changing to all wet food + a little bit of insulin. In August of this year, I noticed her drinking water again... and discovered that her diabetes had come back. She also has pancreatitis (also first diagnosed last year, via ultrasound), and had a few flare-ups earlier this year (not too major - some throwing up but still eating). I (and the vet) guess that the pancreatitis created insulin resistance that caused her diabetes to come out of remission?

I've been kind of following the SLGS protocol this time (with input from the vet), and she's now on 1.5 units twice daily, and has been for about a month (see spreadsheet). Earlier in the month, her numbers were still pretty high, so I asked the vet if we should increase the dose, but the vet wanted her to come in and do some tests, so we went in on 9/23/25. Notable test results are that her fructosamine levels were high (781) and so was the specfPL (a pancreatitis test - she got 44.7 when the reference healthy range is 0-4.4! even though she was not, to my knowledge, experiencing a flare-up). This led the vet to refer us to an internal medicine specialist (we have an appointment in a few weeks) - she's worried that something else could be going on, and I suppose she is at the limit of her expertise.

Interestingly, Prim's numbers have been trending lower in the last couple weeks after going to the vet (on the same 1.5 dose)? There have even been some low pre-shot numbers that I have chosen to skip because I couldn't stay home from work to monitor (and without quite enough data to go off of).

I would love to hear other people's experience with managing pancreatitis jointly with diabetes, as well as any opinions about dosing strategy given her numbers right now.

Thank you! Here's a picture of the cuddly meatball

 

[Wendy&Neko]

Hello and welcome. In addition to the spreadsheet, there are a few other things we'd like to see in your signature - so we don't have to keep asking you the same questions. The details are in this post: New? How You Can Help Us Help You!

The combo of pancreatitis and feline diabetes is unfortunately fairly common. Pancreatitis, or other sorts of inflammation can cause a type of insulin resistance. And could indeed have been why she came out of remission. For more reading: A Primer on Pancreatitis Needing a dental (infection or inflammation) is also a common cause. I hope the vet checked inside her mouth.

Her numbers coming down could be as a result of pancreatitis being treated.

 

[Mary & Jude]

I only came to say your cuddly meatball is adorable!!!! You’re in expert hands with Wendy.

 

[Sienne and Gabby (GA)]

Like Wendy noted, pancreatitis is common in diabetic cats. In fact, my kitty was diagnosed with pancreatitis at the same time she was diagnosed with diabetes. One thing the internal medicine vet may be able to assess is whether this is an acute episode of chronic pancreatitis.

If I may make an observation... I'd encourage you to always get a test before you head off to go to sleep. Many cats experience lower numbers at night and you don't want to miss a dose reduction or the possibility of low numbers where you need to intervene. Right now, you're missing half of your test data. It also sounds like you're following your vet's suggestions regarding dosing. With SLGS, you evaluate the dose on a weekly basis. The problem with holding a dose that isn't bringing Prim's numbers into a closer to normal range is that she becomes accustomed to staying in higher numbers (i.e., glucose toxicity).

 

[primball]

Thanks all for the welcome and your replies! I have added information to my signature. Prim actually had all her teeth removed before I adopted her, so no concern about dental problems causing insulin resistance.

In your experience, can pancreatitis episodes be asymptomatic/no obvious symptoms? I’m a bit puzzled about why the specfpl test was so high because I didn’t think that she was in the middle of a pancreatitis flare-up.

Wendy - what do you mean by her numbers coming down as a result of her pancreatitis being treated? She wasn’t showing symptoms of being in a flare-up, so the vet didn’t do anything special to try to treat her pancreatitis on this visit. But if it is possible that she was in a flare-up without us knowing, maybe her numbers went down when the flare-up had passed?

Sienne - what do you mean by an acute episode of chronic pancreatitis? Also, do you have any advice for what to bring up with the internal medicine specialist to help make sure they’re assessing everything that’s relevant?

And thanks for the advice about testing at night. Honestly, the anxiety of potential hypo really gets me, and I’m not sure if it will make sense for me to try to really lower Prim’s numbers as much as possible. Today I wanted to see how low she would go with a pre-shot number of 150, and the answer was not too low at all (see spreadsheet), but I was a little bit of a mess every time I left the house… And most work days I will be unable to monitor. Anyway, all this to say I tip my hat to all who regulate and monitor so closely!

Lastly, I have a dosing question after the numbers today. I seem to often see cycles where her numbers just go down slowly the whole time, all the way to the next shot. Does this indicate something about the depot? (today was a few days after a skipped shot) Or does it mean the dose is too high if the pattern is that every pre-shot number is lower than the last? (which eventually leads me to skip, like tonight, and repeat the cycle all over again…)

My apologies for writing an essay. Thank you again for your time and thoughts

 

[Wendy&Neko]

what do you mean by her numbers coming down as a result of her pancreatitis being treated?

Sorry, I thought the vet would have treated with a confirmed case of pancreatitis. The primer I linked described the treatments. Inflammation can cause insulin resistance, if the inflammation goes away then the blood sugar values could come down.

That was a lovely cycle today, I'm glad you shot and were able to monitor. It's unfortunate you were not able to shoot the full dose tonight. Lantus really does best when you keep shooting the same dose, due to the nature of the depot.

I seem to often see cycles where her numbers just go down slowly the whole time, all the way to the next shot. Does this indicate something about the depot?

It's situational, I'd have to see the doses shot before the particular cycle in question. A common scenario where the cycle starts high and ends lower, is when a bounce is breaking. Today was not an example of that pattern. Her lowest point was around +5, then she just mostly hovered a little bit above that the rest of the cycle.