/28April20/+8:59/Will/Can Not Eat

bambinaki

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/...etance-vomited-weird-poo.228884/#post-2562770

I am tentatively grateful and relieved that Maxi is much better now. I earnestly hope he stays that way.

I worry that his awful symptoms and suffering were due to the cabergoline. I can't simply stop it; it has to be tapered off. I don't know if I should stop it or not. And if I should stop it, how to go about the tapering off?

Thank you
 
Karen, I really don't know what to suggest. The 142 is quite a bit lower than you have shot before.
As I said the day before yesterday I don't feel qualified to advise you.
I know Marj doesn't like BCSs but I don't think I would give the full dose, but that is just my opinion.
He looks like he is coming off a bounce with those numbers.
 
Bron and Sheba (GA) said:
Karen, I really don't know what to suggest. The 142 is quite a bit lower than you have shot before.
As I said the day before yesterday I don't feel qualified to advise you.
I know Marj doesn't like BCSs but I don't think I would give the full dose, but that is just my opinion.
He looks like he is coming off a bounce with those numbers.
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Oh, sorry Bron, I thought you felt comfortable about insulin alone. I don't think I'll get a response from the others.
Not only is 142 lower than numbers I have shot before, it has gone down from the numbers of last night, even though by now it should be back up.
 
bambinaki said:
Oh, sorry Bron, I thought you felt comfortable about insulin alone. I don't think I'll get a response from the others.
Not only is 142 lower than numbers I have shot before, it has gone down from the numbers of last night, even though by now it should be back up.
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I am comfortable with dosing issues but Maxi has so many other things going on as well and I don't want to suggest something that might not be a good idea.
What are your thoughts?.
I think he is coming off a bounce.
 
Bron and Sheba (GA) said:
I am comfortable with dosing issues but Maxi has so many other things going on as well and I don't want to suggest something that might not be a good idea.
What are your thoughts?.
I think he is coming off a bounce.
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I still have not grasped the what bouncing is.

I just read this:

So how do you know whether to give more insulin or less? First you decide whether or not there is any possibility that hypoglycemia is occurring -- if the cat is unregulated and never has a BG reading below 200, you're probably not seeing rebound.

If hypoglycemia is an unconfirmed possibility, simply decrease the insulin by 20% for three days and see if the spikes disappear. Since food causes blood glucose to rise, it's impossible to differentiate a Somogyi spike from a post-peak food spike -- another argument in favor of restricted feeding.
 
Bron and Sheba (GA) said:
I am comfortable with dosing issues but Maxi has so many other things going on as well and I don't want to suggest something that might not be a good idea.
What are your thoughts?.
I think he is coming off a bounce.
Click to expand...


So, I have no clear thoughts, other than feeling wary of shooting at this number considering it's come down while it should have come up by now.

If he IS coming off a bounce, what it the protocol for that?
 
I guess I will have to wing it and trust my own uninformed judgement. I'll shoot 8.75 in a few minutes unless otherwise directed.
 
Bouncing happens when a cat drops fast, too low or lower than he has been used to.
Maxi dropped low a couple of day ago and also had a skip.
Now his numbers are coming back down and sometimes when they come down they can go lower than normal.
The main thing is to keep Maxi safe.
The other ladies who have been helping you would probably have a different view from me as they know Maxi and may be more confident of what is happening.
In my opinion, with so many other things going on with him, I would give a reduced dose.
 
Remember, the higher dose is still active. Those blues are not a bad place to be either.

How about 7 units? If your home to monitor.

Ollie does this every couple of months. Chasing down ladder. Skipped doses, half doses she will just run no matter what you do. Then you get a break for a day and she does it again. That's the combo of caber and insulin working togethet.

You don't want to skip to much or you will end up going back up in dose.
 
Olive & Paula said:
Remember, the higher dose is still active. Those blues are not a bad place to be either.

How about 7 units? If your home to monitor.

Ollie does this every couple of months. Chasing down ladder. Skipped doses, half doses she will just run no matter what you do. Then you get a break for a day and she does it again. That's the combo of caber and insulin working togethet.

You don't want to skip to much or you will end up going back up in dose.
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OK, I'll shoot 7 units.

PS: He didn't have cabergoline last night.
 
7 it is then. If all goes well, you go back to 9 tonight. As I said before caber because it was a low dose could just be starting to kick in. I think I would give caber separate from food though. You don't know if the ingredients in the binder and the caber at same time are compatible until you Talk to the pharmacist. And all that in the food alone could make Maxi sick.
 
Olive & Paula said:
7 it is then. If all goes well, you go back to 9 tonight. As I said before caber because it was a low dose could just be starting to kick in. I think I would give caber separate from food though. You don't know if the ingredients in the binder and the caber at same time are compatible until you Talk to the pharmacist. And all that in the food alone could make Maxi sick.
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Thank you, Paula. Thanks for answering my plea. I will call the pharmacist now.
 
Here's what the pharmacist said:

  • Mixing cabergoline with binder should have no adverse effect

  • Mixing cabergoline with food or giving it straight -- no difference.

  • Even though Maxi was taking cabergoline for a month without issue, the previous few days of decreased appetite and the last 2 days of awful sickness, the medicine might not have made him sick before but did later because of build-up in the body to a non-tolerable point.

  • Even though Maxi got meds yesterday to alleviate symptoms, his getting so much better without cabergoline suggests it was the cabergoline that made him sick.
 
Guess the pharmacist would know. But I don't think I would give it up so quickly without trying some changes first.

Another thought. Maybe every other day would work fine for Maxi. What was his IGF?
 
Olive & Paula said:
Guess the pharmacist would know. But I don't think I would give it up so quickly without trying some changes first.

Another thought. Maybe every other day would work fine for Maxi. What was his IGF?
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Yes, I'm not happy about possibly giving up on the cabergoline. I will give him a reduced dose tonight.

The pharmacist recommended this tapering off protocol, if I choose to do so: reduce dose by 1/4 every few days.

If I have it straight, his IGF was 500, and his IAA was 0. I could have that backwards. Anyway, I know one test showed that he does not have insulin resistance and the other showed that he has acromegaly.
 
So, while Maxi's diarrhea has stopped and he is able to eat again, he still keeps hiding under the bed, so I know he doesn't feel well.
 
bambinaki said:
Yes, I'm not happy about possibly giving up on the cabergoline. I will give him a reduced dose tonight.

The pharmacist recommended this tapering off protocol, if I choose to do so: reduce dose by 1/4 every few days.

If I have it straight, his IGF was 500, and his IAA was 0. I could have that backwards. Anyway, I know one test showed that he does not have insulin resistance and the other showed that he has acromegaly.
Click to expand...

the IGF is the acro test. Being that high I would not give it up easily. Try giving the 30 mcg every other day by itself. See if that makes him sick. Like pharmacist said he was on it long enough without an issue. Maxi might have just had a tummy upset from anything. You won't know if it's the caber until you try it again. Then if he is sick you know that's what is probably the cause. Ollie has bouts of being sick but it's usually the p'titis or straining from poop after constipation. She has to many good days in a row for caber to be blamed. And Maxi could have been I'll from that stretch of greens he isn't use to and any hc, syrup you might have given.

There are so many reasons. It's hard to pin point any one cause until you do trial and error to narrow it down.
 
Result of yesterday's pancreatitis test: 22.2 (reference range is 0 - 3.5)

Any advice re. pancreatitis would be appreciated.

What caused it? What should I do about it?
 
Olive & Paula said:
the IGF is the acro test. Being that high I would not give it up easily. Try giving the 30 mcg every other day by itself. See if that makes him sick. Like pharmacist said he was on it long enough without an issue. Maxi might have just had a tummy upset from anything. You won't know if it's the caber until you try it again. Then if he is sick you know that's what is probably the cause. Ollie has bouts of being sick but it's usually the p'titis or straining from poop after constipation. She has to many good days in a row for caber to be blamed. And Maxi could have been I'll from that stretch of greens he isn't use to and any hc, syrup you might have given.

There are so many reasons. It's hard to pin point any one cause until you do trial and error to narrow it down.
Click to expand...


While the pharmacist said it's impossible to say what caused Maxi to be sick, he also said the cabergoline is suspect -- that it didn't make him sick for weeks but then the build-up of it in his system made him sick.

I will go ahead and give him his full dose tonight as you said, Paula, and then every other day. It's OK with pancreatitis to do that?
 
Bron and Sheba (GA) said:
Karen, I really don't know what to suggest. The 142 is quite a bit lower than you have shot before.
As I said the day before yesterday I don't feel qualified to advise you.
I know Marj doesn't like BCSs but I don't think I would give the full dose, but that is just my opinion.
He looks like he is coming off a bounce with those numbers.
Click to expand...
I just want to clarify. I don’t like BCS doses for non-high dose cats. Almost all of the time, a BCS dose for those cats is for the CG and not the cat.

However, for a high dose cat, there can be some benefit to shoot a BCS dose and drain the depot a bit. In this case where the kitty was getting 9.25u, shooting 7u reduces the depot by 2.25u which is a larger dose than many non-high dose cats are on. Yes, that still leaves a large depot to deal with (7u) but it can help and especially when the kitty has been off food. (I’m glad he’s eating well today).
bambinaki said:
Result of yesterday's pancreatitis test: 22.2 (reference range is 0 - 3.5)

Any advice re. pancreatitis would be appreciated.

What caused it? What should I do about it?
Click to expand...
Did you read the Primer I linked yesterday as that has a pretty exhaustive amount of info for you including treatments. I doubt anyone can tell you what caused the pancreatitis. One possibility is certainly the diabetes connection but I once had a civvie that had one acute case of pancreatitis and never had it again. It was sudden onset, we treated aggressively, and he was much better in a couple days.

Pancreatitis is much more common in cats than was previously thought. In a large group of necropsies done on cats, over 50% showed evidence of pancreatitis at some time during the cats’ lives. Cause of death was not pancreatitis-related. Good vets will suspect pancreatitis if the cat is brought in because the CG thinks things are “just not quite right”. That means symptoms are subtle....inappetance, lethargy, and generally just “off” for a couple days. These cats may have a very mild case of pancreatitis.

The fact that pancreatitis is diagnosed doesn’t affect the dose of insulin you give. You need to see where his BG is to make that determination. See how the cycle goes but if he has a nice, flat cycle or comes up, I’d agree with 9u.
 
Marje and Gracie said:
I just want to clarify. I don’t like BCS doses for non-high dose cats. Almost all of the time, a BCS dose for those cats is for the CG and not the cat.

However, for a high dose cat, there can be some benefit to shoot a BCS dose and drain the depot a bit. In this case where the kitty was getting 9.25u, shooting 7u reduces the depot by 2.25u which is a larger dose than many non-high dose cats are on. Yes, that still leaves a large depot to deal with (7u) but it can help and especially when the kitty has been off food. (I’m glad he’s eating well today).
Did you read the Primer I linked yesterday as that has a pretty exhaustive amount of info for you including treatments. I doubt anyone can tell you what caused the pancreatitis. One possibility is certainly the diabetes connection but I once had a civvie that had one acute case of pancreatitis and never had it again. It was sudden onset, we treated aggressively, and he was much better in a couple days.

Pancreatitis is much more common in cats than was previously thought. In a large group of necropsies done on cats, over 50% showed evidence of pancreatitis at some time during the cats’ lives. Cause of death was not pancreatitis-related. Good vets will suspect pancreatitis if the cat is brought in because the CG thinks things are “just not quite right”. That means symptoms are subtle....inappetance, lethargy, and generally just “off” for a couple days. These cats may have a very mild case of pancreatitis.

The fact that pancreatitis is diagnosed doesn’t affect the dose of insulin you give. You need to see where his BG is to make that determination. See how the cycle goes but if he has a nice, flat cycle or comes up, I’d agree with 9u.
Click to expand...

I take it that you agree that the 7 units was the right move in Maxi's case this morning?

I really hope Maxi's pancreatitis was one of the one-time cases.
Yes, I read the primer you linked. Thank you.

So if his numbers don't go down from now -124- I should give him 9 units?
 
bambinaki said:
I take it that you agree that the 7 units was the right move in Maxi's case this morning?

I really hope Maxi's pancreatitis was one of the one-time cases.
Yes, I read the primer you linked. Thank you.

So if his numbers don't go down from now -124- I should give him 9 units?
Click to expand...
Yes on this morning’s dose. Let’s see how the cycle plays out. I hope you are testing again soon because he was still coming down at +3.
 
bambinaki said:
Result of yesterday's pancreatitis test: 22.2 (reference range is 0 - 3.5)

Any advice re. pancreatitis would be appreciated.

What caused it? What should I do about it?
Click to expand...
I thought there was a good chance this is pancreatitis. The pancreatitis primer has lots of info. Max had chronic pancreatitis. At this point I do t know if this is an acute attack or not. In a nutshell though treatment is based upon symptoms. Sub-q fluids, nausea medication, pain medication. Feeding several small meals as opposed to a lot at once is also recommended because when they start to feel better and eat too much they can feel yucky again. Is the stool now normal? With Max he had loose stool only a few times over the ndny years of pancreatitis and it usually was a one or two times and done. Once on a holiday weekend I got flagyl just in case but never needed it. He always became inappetent or fussy about food. He was eating but less when first diagnosed and so it never occurred to me he could be nauseous until it was pointed out to me by someone on a kidney group I belonged to. At that point he didn’t gave kidney disease but the moderators there are so knowledgeable on everything cat.
 
tiffmaxee said:
I thought there was a good chance this is pancreatitis. The pancreatitis primer has lots of info. Max had chronic pancreatitis. At this point I do t know if this is an acute attack or not. In a nutshell though treatment is based upon symptoms. Sub-q fluids, nausea medication, pain medication. Feeding several small meals as opposed to a lot at once is also recommended because when they start to feel better and eat too much they can feel yucky again. Is the stool now normal? With Max he had loose stool only a few times over the ndny years of pancreatitis and it usually was a one or two times and done. Once on a holiday weekend I got flagyl just in case but never needed it. He always became inappetent or fussy about food. He was eating but less when first diagnosed and so it never occurred to me he could be nauseous until it was pointed out to me by someone on a kidney group I belonged to. At that point he didn’t gave kidney disease but the moderators there are so knowledgeable on everything cat.
Click to expand...


Thanks, Elise.

What kidney group is that? My Maxi also has kidney disease.
 
Sandy and Black Kitty said:
When, what and how much did he last eat?
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About 2 hours ago I rewarded him with 1-2 teaspoons of tuna after taking cerenia. *SEE BELOW He took the cerenia in a pill pocket. 2 hours before that he had some Weruva. Right now he's having Wellness turkey pate. 6 hours ago he had Weruva. He's eaten about 2-3 tablespoons of Wellness just now.
 
This morning breakfast I thought his appetite was back 90%.

Right now he's again acting like he would like to eat, but he's kind of forcing it.

He's eaten almost the full amount of Wellness I gave him -2-3 tablespoons. I just gave him a tablespoon og another kind of Weruva, and he's sort of forcing himself to eat it.
 
bambinaki said:
About 2 hours ago I rewarded him with 1-2 teaspoons of tuna after taking cerenia. He took the cerenia in a pill pocket. 2 hours before that he had some Weruva. Right now he's having Wellness turkey pate. 6 hours ago he had Weruva. He's eaten about 2-3 tablespoons of Wellness just now.
Click to expand...
Easy does it with food; you want him to be a little hungry- it’s still relatively early in the cycle and you may need to steer the numbers upwards. Check BG 30 mins after he finishes the meal he is eating right now.
 
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