? 2/27/2024 Bugs SKIP AMPS, 203 +6AMPS, 227 PMPS

[SKittyMom]

Hi,

It's been a while since I've needed to reach out on behalf of Bugs. Unfortunately, last week Bugs had a bit of a setback due to some health issues.

On Sunday 2/18 we noticed Bugs was not wanting to eat as much and was not drinking water. This continued on Monday 2/20 as well. Her BG levels were also increasing (see spreadsheet), and she was not responding to her Insulin. On Tuesday 2/21, I called the vet, and we took her in. After her examination it was determined she was somewhat dehydrated and received fluids. Bugs was scheduled for her annual exam the following day, so the vet went ahead and ran her senior panel. On 2/22 the vet called us to review the lab results. The most concerning was her ALT at 1,135 and her AST at 935. The vet recommended we take Bugs to our local pet hospital to have an Ultrasound completed as everything was pointing to possible liver issues. We took our vets advice and immediately took Bugs. Bugs was diagnosed with Pancreatitis and bordering Steatitis. Bugs spent the night & next day at the hospital so she could be monitored and receive the appropriate treatment/care.

Prior to Bugs being discharged on 2/23 the doctor contacted me to discuss her home care. Part of her recommendation was to monitor Bugs BG levels using the Libre over a 3-day period, which we agreed to. Her other recommendation was to discontinue Bugs Insulin as she felt Bugs was currently in remission. (Bugs has not had any Insulin since 2/21.) The doctor’s recommendation was based off the BG levels Bugs has been maintaining over the last 12 months.

Bugs was also prescribed the following medications and is currently no longer taking:

• Mirtazapine Transdermal Ointment 2 times daily to increase appetite
• Ondansetron 2 times daily as needed for decreased appetite or nausea
• Gabapentin 2 times daily as needed for pain.
• Maropitant 1 time daily for decreased appetite.

The Libre showed Bugs BG levels all over the board. She had frequent number dipping into the 50's showing she was in hypo level. I reached out to the pet hospital and they stated the Libre monitor was probably no longer responding properly so I have scheduled an appt. tomorrow to have it removed. This afternoon we resumed testing with our ReliOn Monitor.

So, with all this said, my concern is that Bugs is not on Insulin at this time, and we don't want her to continue with the upward trend. What would you recommend? Should we start her back on her prior dose of 0.1 unit and see how she does?

I apologize for the length of this post. It has been quite a journey for Bugs this past week and our hope is to get her back on the path she was on.

Thank you so much!

 

[Wendy&Neko]

I'm sorry to hear Bugs has been unwell. Have you read the post A Primer On Pancreatitis

Bugs numbers look like she still needs some insulin. Pancreatitis is painful and the inflammation can also cause an increase in her blood glucose. By the way, since she was seeing higher blues and above, she didn't look like a cat in remission. Since you stopped insulin, have you tested her lately for ketones? And yes, I'd start back at 0.1 to see if you can get her out of the yellows to start.

We've seen varying results here with the Libre. Some people find them not too far out, but the Libre usually shows much lower in low numbers. It's best to test with a handheld meter is you see a low Libre number. That 50 Libre, which is a normal blood sugar value, not hypo in most cats, can register a lot higher on the BG meter. I've personally tested non diabetic cats in the low 50's and even upper 40's.

I am surprised about some of the medication dosing. Mirtazapine (Mirataz) is dosed once per day, not twice. What dose of ondansetron were you giving and how much does she weigh? Vets often underdose it, and it can be given up to 3-4 times a day if needed. Is she eating well now? Maropitant is metabolized by the liver, and should be used with caution in cats with liver disease. Is anything being given to help with the liver issues?

Could you put NS (no shot) or skip on the spreadsheet to shot that you have stopped giving insulin. Or some other notes so we know you didn't just forget to fill it in.

 

[Diane Tyler's Mom GA]

 

[SKittyMom]

I'm sorry to hear Bugs has been unwell. Have you read the post A Primer On Pancreatitis

Bugs numbers look like she still needs some insulin. Pancreatitis is painful and the inflammation can also cause an increase in her blood glucose. By the way, since she was seeing higher blues and above, she didn't look like a cat in remission. Since you stopped insulin, have you tested her lately for ketones? And yes, I'd start back at 0.1 to see if you can get her out of the yellows to start.

We've seen varying results here with the Libre. Some people find them not too far out, but the Libre usually shows much lower in low numbers. It's best to test with a handheld meter is you see a low Libre number. That 50 Libre, which is a normal blood sugar value, not hypo in most cats, can register a lot higher on the BG meter. I've personally tested non diabetic cats in the low 50's and even upper 40's.

I am surprised about some of the medication dosing. Mirtazapine (Mirataz) is dosed once per day, not twice. What dose of ondansetron were you giving and how much does she weigh? Vets often underdose it, and it can be given up to 3-4 times a day if needed. Is she eating well now? Maropitant is metabolized by the liver, and should be used with caution in cats with liver disease. Is anything being given to help with the liver issues?

Could you put NS (no shot) or skip on the spreadsheet to shot that you have stopped giving insulin. Or some other notes so we know you didn't just forget to fill it in.

Good Morning,
@Wendy&Neko Thanks for getting back with me.

Bugs was tested for Ketones and nothing was present in her urine so all good there.
The Ultrasound showed her liver looks normal so we did not need any further treatment for this.

Here is the dosing details:

• Mirtazapine Transdermal Ointment 1 times daily to increase appetite - 1 1/2 inch strip on the inside of ear with a gloved finger every 24 hours. (Sorry I noted 2 times but we did once daily.)
  
• Ondansetron 2 times daily as needed for decreased appetite or nausea - 4mg tablets, 1/2 tablet every 8-12 hours as needed
  
• Gabapentin 2 times daily as needed for pain - 50mg tablets, 1/2 tablet every 8-12 hours as needed. We stopped using this per the doctor on 2-23 as Bugs became very lethargic.
• Maropitant 1 time daily for decreased appetite - 16mg tablets, 1/4 tablet by mouth once a day as needed.

Bugs has not had any of her medications since Sunday 2/26.

Bugs currently weighs 14lbs. She is eating again and we have seen her appetite increase over the last couple days which is great. Taking in water as well.

We started back on our normal hand meter testing and the Libre is getting removed today at our vets office. This morning we started her back on her 0.1 dose of Insulin. Hoping after a few days we will see her numbers start to drop. (Fingers crossed.)

I'll read the post recommended on A Primer On Pancreatitis. Thank you for sharing that. I admit this past week I did not even think of looking at info on the site as I was so focused on the info we were receiving from the Doctor.

I updated the spreadsheet as you suggested.

Since bugs was without Insulin for a week, do you have any thoughts on when we should hopefully see improved numbers or when I should reach out to see if we should alter her dosage?

Thanks again!

 

[Wendy&Neko]

Are you home testing for ketones?

The depot takes 5-7 days to build. You might see better numbers before then though. I see green today already.

 

[SKittyMom]

Are you home testing for ketones?

The depot takes 5-7 days to build. You might see better numbers before then though. I see green today already.

I got a little excited when I saw that green as well! Thanks for the timing info. I will reach out if we need any help through this. Have a great day!