? 6/27 Goose AMPS 376, +3 355, 0.2U, has diarrhea. Should we change dose?

Anshu and Goose

Anshu and Goose

Member Since 2023
For continuity:

Based on the feedback on our last post, we made the following changes to Goose's care:
  • Reduced his test, feed and inject cycle to ~15-20ish minutes. Test for BG, offer food, and inject once he's eaten half his plate.
  • Offer him 4 meals: One big meal after AMPS, and a smaller one at noon. In the evening, big meal at 7 PM and small meal around 10 PM, after PMPS +3. (All of them Fancy Feast Classic Chicken - pureed, use churu tube treats to keep him still during BG measurement)
  • Moved to TR and are testing 3-4 times during the day and once after the PM shot (PMPS +2/3).

We kept him on 0.1U for 6 cycles and his curve looked stable but BG values were high. On 6/25, we increased his insulin to 0.2U. He seemed to bounce the same day, and has been high since.

He has been testing negative for urine ketones (tested daily), has good appetite, and is drinking water. The only issue is diarrhea - it keeps coming back. We tried fortiflora for a few days - didn't help much. Then we gave him canned pumpkin and florastor (1/2 capsule 2x a day for 2 days), but yesterday his diarrhea was the worst. We finally got Metronidazole tablets from the vet and it is a 5-7 day course.

Should we increase his insulin dose if his BG doesn't reduce after 6 cycles on 0.2 U, or would it be better to wait till the diarrhea clears out? Since Goose also has a history of pancreatitis and we've read that high blood glucose can also cause diarrhea - we are not sure what's the best approach here. We do have concerns about seeing the bouncing with increasing insulin.

Thank you for reading this and offering advice! We sincerely appreciate it.
 
I have not seen many cats with diarrhea due to high glucose. I would not wait to increase with his bg numbers. How long has the diarrhea been going on? Good appetite? Everything else normal? Playing? Showing any signs of pancreatitis?
 
Thanks for the reply @tiffmaxee . He first had diarrhea around 6/7. He was on a Hills Rx dry food diet then, and his diarrhea stopped as we transitioned him to low carb canned wet food. Recently, he had diarrhea on 6/19 overnight and then since 6/23. Saturday (6/24) and yesterday (6/26), his diarrhea was definitely bad - he would struggle to poop, and vomit immediately right after. In one instance, he vomited his evening meal, but was happy to eat more food afterwards.

Other than that, his appetite is good - he's eating almost 250kCal / 200g of canned food (9.5 lb bodyweight, so roughly in the range). He has been sleeping a lot since his diabetes first started, but starting playing with toys occasionally in the last few days. Based on the symptoms list on this post (A Primer on Pancreatitis), the main symptoms Goose is exhibiting are diarrhea and vomiting.

We can start him on higher insulin tomorrow morning and monitor him throughout the day. Would shooting 0.4 U be okay?
 
FortiFlora is not a wonderful probiotic for treating diarrhea. To be honest it works better as a method for enticing a cat to eat. It has much of the same product as is used as a coating for kibble. The best probiotic I've found for diarrhea is S. boulardii. Either ReNew or Jarrow's are poplar products. You start with about 1/4 to 1/3 of a capsule mixed into your cat's food.

One thought since your vet was raising the question of IBD. You may want to try feeding Goose a food that is a novel protein. For most cats with IBD, they become sensitized to the proteins they have a history of eating. My IBD kitty was raised on both turkey and chicken. Switching her to a combination of a partially raw diet (pork), ZiwiPeak venison, and Stella & Chewy's rabbit has made a world of difference.

If you are following TR, you need to hold the current dose for a total of 6 cycles. If you take a look at the sticky note regarding the insulin depot, Lantus needs at least 6 cycles for the dose to become established. If you make rapid changes in the dose, the result is wonky numbers since the depot hasn't stabilized.
 
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