Berkeley Girl hospitalized

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barbp

barbp

Member Since 2014
Not good news, and I am not sure which comes first, the diabetes or the pancreatitis. One thing I had commented on early in the game with Berkeley, was that her stool smelled. I was thinking giardia, young vet tested for regular worms, not giardia, and all was normal.

After her possible carbo binge on the dry food Wednesday, I was relaxed as her blood levels came down to the normal high 400s and low 500s and she was eating normal. But I had made a vet appointment for this Friday a week ago as she felt much lighter and I was concerned that the reduced calorie and carb diet was causing her to lose weight too fast.

But on Thursday, she was difficult to get to eat (I actually had to add pieces of dry food to the wet) and this was something Berkeley never did-not eat. Plus she was having little belly spasms, like hiccups? And then Friday morning, she would not eat when I place the food in front of her after her lantus shot (and I had just increased it to the 2 units dosage). So I am really nervous now- cat not normal, lots of insulin, no food, etc.

Vet felt she was too lethargic (although since I have had her (June 2013) I have never seen her play or walk faster than an amble) and she hissed when her abdomen was palpitated, This vet seemed interested in the smelly stools and the twitching tail and basically said, as a guess, it is pancreatitis, perhaps chronic. Which does not have a good prognosis. Seems acute is better to have.

And she had lost too much weight-about 3 lbs in the one month, mostly muscle tissue as she still had fat over her ribs but her spine could be felt. I guess I should have just left her on the higher carb wet and fed as much as she wanted and just regulated with the insulin dosage. Confusing and sad.

So, now to wait and hope.
 
Pancreatitis may damage the ability of the pancreas to produce digestive hormones which will make it difficult to digest food. Ask about supplementing with digestive enzymes.

Pancreatitis Primer
 
thank you BJM. Vet called at 9pm. The xray showed an extremely filled bowel so they did enema and removed a lot of stuff-vet guesses that part was the large amount of dry food she gorged on the other day, plus there was bark strips from my cat trees. And here I thought the cat was sleeping most of the day!

The blood work is sent out, she has been hydrated, glucose levels are less elevated and they got her to eat a bit by hand and she was eyeing the food they had left. Vet said her opinion was the cat was in less pain and more alert. Currently she thinks Berkeley does have pancreatits and is treating her for that (?) but will know further tomorrow when labs come back.

I did not press any further questions as she had received my email with the glucose readings since 3/1 and my 9am/pm lantus dosing etc

With hope-maybe will turn out to be a touch of colic or I guess it is called gastritis?
 
Wendy, thanks for your concern. She is alive. I am quite frustrated and angry with the vet. Simply put, she went in Apr 4, had started her on 2 units that morning.

I just got her home yesterday evening, Apr 10, and she is on FOUR units 12-12 plus amoxicillin 2x daily. My take, and vet sort of concurs, is that her binge on dry food Apr 3, was a real binge and she was stuffed from the intake to the outtake! After her enema, she was quite herself, eating etc, well, but the vet, (who had said she believed in SLOW insulin changes), just kept upping and upping her lantus, telling me she was above 400 all the time.

And to top it off, tonight when I gave her the 4 units lantus shot, I MISSED the inside of the cat. When I took my hand away, I could smell the lantus on my fingers, and could even see the area of wettish hairs. At least I know the other shots have been done correctly but I tell you.....

Forgot to mention-the reason I had scheduled the appointment a few weeks earlier (thank goodness I had the appointment) was that Berk seemed much lighter. Well she is. At Feb 28 visit she was 16 something and on the april 4 visit she was 13 something and when she left the vets on Apr 9 she was 13 lbs 3 oz. I have increased her FF cans from 4 to 6.

I have not asked vet, but from what I see here, other vets give short acting insulin along with the lantus while in the hospital. They did not, and I am wondering it poor Berk is suddenly going to shoot downwards and I may not catch it. Vet wants her back next thursday or Friday for a day stay.
 
Let me see if I understand this correctly.

Your Berkeley started at 2U Lantus on 4/4, twice a day for a total of 4 unit of insulin.
Your Berkeley is now at 4U Lantus as of 4/10, twice a day for a total of 8 Units of insulin.
The dose was doubled in a matter of 6 days?

Did I get that correct?

Looks to me like dose increases were made too rapidly. We only raise doses in 0.25U increments, so you do not bypass the appropriate dose for your cat. We also hold the dose for a minimum of 6-10 cycles unless the BG reading drops <50 on a human glucometer, which earns your cat an automatic reduction in dose of 0.25U. You have very likely bypassed the appropriate dose for your kitty.

Do you have any more BG (blood glucose ) readings to share with us? Especially from Berkeley's time at the vet, or is your SS up-to date with all the BG readings. I'd be interested in seeing how often they were testing her. I don't see any tests in the +5 to +7 hour time frame, the normal nadir time for a cat and the BG number that you need in order to know how low the BG went and that is the number that dose changes are based on. Also, how often were they feeding her and what were they feeding?

Since vet stress can easily raise BG levels 100-180 points, I hope your vet took this into consideration before the dose was raised.
 
H Deb-
the SS is updated-she was at vet 4/4 thru 4/9-I wrote it in the remarks column-yes they raised her almost daily-the only readings I have from the vets is from my monitor which they had asked for so they measure her readings with the same blood on both the vet one and mine. It was supposed to have been used from sunday 4/6 (when I dropped it off) through the 4/9, but from the memory, I think the techs forgot a number of times. (the morning pre shot readings are missing twice). The vet did comment that she thought Berk was very laid back at the vet and I sort of agree-as long as she is sitting around with food, she does not seem to care whether she is home, outside or elsewhere.

Do you know if the dr roomp (sp?) article is on the forum verbatim to print? I found it on the web but it said I had to be a health care practitioner, research etc or pay money? I guess I could send the vet the link to the article and she could get it for free but I think I would like to read it also-

The sum total of answered question is none-I do not know if the blood tests showed definite pancreatits or if the episode was just a case of overeating and blockage; If the extreme weight loss was due to the cutback in calories for a month from 20 oz of food to 12 oz of food daily or if it was due to the diabetes ravishing her muscles; and I have no idea why they raised her so quickly lantus wise and what will be happening at the end of five days when the lantus effect kicks in or if we indeed have swooped by her optimum dosage-and maybe created insulin resistance?

I seem to recall a forum about educating vets so will check this out-

Anyway, currently Berk is eating well but not ravishingly-I increased her total food consumption to 18 oz per day and she will leave food in the dish now at each feeding, she is walking well and jumping and cleaning herself and watching birds etc-and she can smell those temptation treats a mile away! She just came over to me and started smelling the floor where I had fed one of the other cats a treat! She must like carbs the way I love sugar.
 
In the upper right corner of the page is a search box.
Enter Roomp and Rand, then search.
Numerous posts will come up with it mentioned, attached, or linked.
 
There is a copy of the full version of the original Roomp & Rand article here.

There were some updates along the way, such as only letting newly diagnosed cats, those less than 1 year since diagnosis, only drop to 50 mg/dL once before reducing the dose. It's a built in safety margin to keep cats safer and prevent hypoglycemia.

We here on the FDMB have incorporated some of those changes and made things easier to understand for more people in the modified lantus protocol we use here. That can be found over in the Insulin Support Group (ISG) Lantus-glargine Tight Regulation forum, here.

Our post over in Lantus TR has some more links to the protocol and other articles, like to an article from the vet journal Vet Clin Small Anim 43 (2013) 251–266 http://dx.doi.org/10.1016/j.cvsm.2012.12.005 called "Management of Diabetic Cats with Long-acting Insulin"

There was a special edition of that Vet Clinic Small Animal journal devoted entirely to Feline Diabetes back in March 2013. So that may be a good resource to point your vet to.
 
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