Cami - IBD?, mega colon. Was OTJ, now BG out of control

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Sheila & Beau GA & Jeddie GA

Sheila & Beau GA & Jeddie GA

Member Since 2009
Cami, adopted last Oct. was pretty quickly regulated on a small dose of lev and went OTJ early this year. She always had some "digestive issues" with bloating, gas, noises. When I first had her she vomited several times a week and had occassional diarrhea. After she vomited up a plant stem of some kind the vomiting and diarrhea stopped and her BG dropped as well.

Since then, even when OTJ she drank huge amounts of water (up to 2 cups a day) even though she is fed canned food with water added. She had an urgent respiratory situation in March that was probably pneumonia but all the testing revealed severe abdominal inflammation (all organs) with fluid built up. She was treated with pred and ABs and got a lot better. Still drinking huge amounts. Then, quite suddenly she was severely constipated. After two weeks of ER and urgent vet visits she was diagnosed with mega colon. She was put on cisapride, lactulose, potassium, subQ fluids and stayed on the pred. At first her BG would climb slightly and .15u as needed kept things in check. She even spent 4-5 days below 100 with no insulin after her 26 hr ER visit. After the third blockage, the lactulose was raised and miralax added. Her BG started to climb. And climb. Now she is barely out of the 300s and is spiking into the 400s. One odd thing is that she is drinking less water now, even with the high BGs.

I am at my wits end (didn't take me long to get there!). I must be missing something. Or I just have to keep raising the dose.

Any thoughts appreciated.
 
Sorry to hear she is having so many issues.. I have a few questions to see if we can find out what's going on.

1. Food.. What type flavour brand? Wet? Dry?
2. Pred.. Is she still on it?
3. When you say 0.15 I assume you mean 15units?

Wendy
 
Thanks, Lyresa.

Wendy, Cami gets canned food: Wellness mixed with Great Choice 1:2, with 2/3 can of water added. She is still on pred. I don't think that it is really causing the issue because she was on it for 2 months before her BG went up. I think it's the lactulose, but even that was manageable until her dose went from 1ml bid to 3ml bid. I only had her on that for 2 day, then decreased to 2ml for two days and then to 1.5ml bid. She is on 1.1ml bid now.

No, .15u is less than a quarter unit. It was working fine when her BG would sometimes creep over 140. That worked the whole first two months of all her health issues outlined in my first post. Then her BG started climbing and I started raising her dose.
 
Hi Sheila! Vets differ in their opinions on Lactulose. Some say it is a nondigestible sugar and passes through the body. Others say that a small percentage of the Lactulose is absorbed by the cat and should not be used by diabetics. Hard to say which is correct. Some recommend Miralax only. Here are two conflicting vet references related to the Lactulose:

http://www.marvistavet.com/html/body_lactulose.html
“Lactulose should not be taken by diabetics. Even though lactulose is not readily absorbed by the mammalian intestine, there is still a small percentage which is absorbed. In addition, there may be some unbound fructose or galactose in the syrup, enough to be a problem for a well-regulated diabetic.”

http://endocrinevet.blogspot.com/2011/1 ... sugar.html
"Lactulose is a synthetic, nondigestible sugar developed as a treatment for chronic constipation. It is a disaccharide formed from one molecule each of the monosaccharides fructose and galactose. Because it is not digested, lactulose passes unchanged to reach the colon, where it exerts its osmotic laxative effect.Therefore, the lactulose did not contribute to your cats diabetes since the "sugar" in lactulose is not absorbed. Similarly, the drug would not be an issue contributing to the lack of response to insulin therapy in this cat."
 
Melanie, I find it very "suggestible" that her BGs went out of control with the increase in lactulose dose. What is confusing that is that her BG has not come down with a decrease in lact dose. I wonder if insulin resistance has set in? I am trying to ween her off lactulose because of this and because it causes her so much discomfort from gas and bloating.

When she was diagnosed first with the inflammatory disease and then again with mega colon I said "Oh, diabetes is easy to work around other issues..." :roll: Well, not so. Or at least I haven't found the right dose yet.

I may be in denial about increasing her lev. I have never had a cat need more than 1u bid.
 
Sheila, my Baloo had megacolon, and he was always bloated and gassy. Even tho he was overweight and large, he had this "bowling ball" body. The vet attributed the gassiness to that-his shape. He was all filled with gas (stomach/intestines) at the end, and the vet attributed that to the dka/ketones but I think it was all part of the megacolon, made worse by DKA. The gas built up because he had lost motility totally and stopped eating.

I don't like lactulose, its sticky and gross. Miralax is much easier. BUT, megacolon is NO picnic, and you need to use what you need to use to keep the poop going, and adjust the insulin around it. I confess I didn't test Baloo as often as I should, but his bg would spike when he was constipated or gassy, and it was very hard to figure out dosing. For a while we had double digits..and then he couldn't poop again.

I am sending lots of cyber hugs to you and Cami.
 
My Oliver has megacolon, and he gets fluids every 2nd day 100ml, plus his meds are miralax in his 2 main meals, 7.5mg cisapride TID, 3ml lactulose BID, and 1 senakot on Tues and Fri.... and lots of souped up food.

you need to juggle around the amounts of each to get just the right combo, and then it's just adjust the miralax and lactulose as needed, depending on the condition of the 'output'.
 
Gayle and BJ, I am not specifically concerned about mega colon (knock wood / anti jinx) that seems to be under control with her current treatment plan. Although I do want her off the lactulose if possible because of the gas and bloating it causes - and I wonder about it contributing to the higher BGs. THAT is my concern here. I don't seem to be able to make headway with her BG control. She just sits in the 300s.

Originally, she never was above .75u before a rapid decrease in BGS/dose and then OTJ. Now she is at 1.5u and it isn't making a dent.

Gayle, Oliver is acro, right? I can't remember. I have had concerns about Cami being acro or Cushings from the beginning because of the belly bloat, thin skin and protruding jaw (profile). During the pneumonia/abdominal inflammation early stages I asked about that with the internal med specialist. She thought no based on her being OTJ at the time. But I was just reading a high dose post where you listed several acros who went OTJ very rapidly and were off insulin for long periods of time.

Am I right that mega colon happens with acro? Like, there is a higher incidence of it in acros? I just feel like there is a key puzzle piece missing here.
 
I was thinking that some of the info on the Feline Constipation might give you ideas about alternatives to the lactulose which you might discuss with the vet and possibly try out.
 
From all the research I have done, in general, on the Yahoo mega colon site, and the one you linked, plus some one on one with an FDMB member that has a civvie with mega colon, it seems that Cami is on all the accepted meds, including lactulose. From what I have read, Miralax is fast becoming, if not already, the preferred stool softener over lactulose. Hence my goal of weening her off lact. I have been slowly increasing the miralax and decreasing the lact. She also gets pumpkin added to her food.

I just don't know that this will help her BGs. She shot up after just one day of 3ml bid, but is still climbing even though I have brought her back to 1ml bid
 
Sheila & Beau & Jeddie (GA) said:
Gayle and BJ, I am not specifically concerned about mega colon (knock wood / anti jinx) that seems to be under control with her current treatment plan. Although I do want her off the lactulose if possible because of the gas and bloating it causes - and I wonder about it contributing to the higher BGs. THAT is my concern here. I don't seem to be able to make headway with her BG control. She just sits in the 300s.

Originally, she never was above .75u before a rapid decrease in BGS/dose and then OTJ. Now she is at 1.5u and it isn't making a dent.

Gayle, Oliver is acro, right? I can't remember. I have had concerns about Cami being acro or Cushings from the beginning because of the belly bloat, thin skin and protruding jaw (profile). During the pneumonia/abdominal inflammation early stages I asked about that with the internal med specialist. She thought no based on her being OTJ at the time. But I was just reading a high dose post where you listed several acros who went OTJ very rapidly and were off insulin for long periods of time.

Am I right that mega colon happens with acro? Like, there is a higher incidence of it in acros? I just feel like there is a key puzzle piece missing here.
Click to expand...

Sheila,
Yes, Oliver is acro, but he got quite ill from vaccines Dec21/2011, and by Jan7/2012 he was completely off insulin.
Looking back now, I think he had the megacolon coming on from the day he arrived, but now, it's front and center.

I think with megacolon, you are always juggling the meds, to help with stool output, but if you think that the lactulose is disrupting the numbers, why not try cutting back? What dose are you giving now? Maybe cut it in half and give it a couple days. We were not sure if Oliver was getting too many meds, so we tried eliminating / adjusting doses, but when we cut back, he got worse.

What about cisapride? Maybe talk to the vet about cisapride and cutting down on the lactulose? Also, Senakot is a good softener that you could try in the mix.

As for cushings, I am not sure about that.... if you are dealing with very thin skin and some tears, then it may be something you want to test, but the tests are not firm like the ones for acro and IAA.

Yes, there are more and more acros that are surfacing.... there's one, Chuck, in BC, who was on insulin for a short time, got to a shot of 6 or 7u, then poof, his numbers just went normal and he was off insulin. I have spoken to Gina recently and she said that he had a pancreatitis bout or something and pop, his numbers are up again and he's getting a small amount of insulin.

There's Linda's Guinness who was just a normal diabetic from the looks of his numbers, then he want OTJ for over a year. When he relapsed, the 2nd time his dose rose and she had him tested.

There's Carolyn's Fletcher who went OTJ 3 or 4 times in his life, and he was acro.

We are noticing more of the signs and the resistance earlier, and owners are getting quicker at going for SRT if they can which seems to help them alot.

If you notice signs and you want to test your cat, just tell you vet what you want.
The cat does not really need to by high dose, and there are also IAA cats who may not be at high doses, but they are wicked hard to regulate.

One big thing we are finding with acros is that the heart is most commonly affected, and it's known as the silent killer for a reason. You can run down the signs for acro and see how many apply to your cat. Snoring or noisy breathing is fairly common, weight gain, pot belly, organs enlargement, lower jaw with separation between the canines, and more.

I guess if you wanted to test you could, but what about an echo, Xrays and u/s to see what's happening inside?

Gayle
 
http://www.drugs.com/sfx/lactulose-side-effects.html

http://www.drugs.com/search.php?searcht ... de+effects

http://www.drugs.com/search.php?searchterm=Senokot

I would talk to the vet about trying an alternative to the lactulose... Ollie does not like it but gets it.

Also, for the insulin resistance, all you can do is follow the protocol, holding a dose for 6 cycles, then up the dose for Cami. If you get up to a 5u dose and still getting the same pullback, then maybe it might be a thought to consider acro and IAA tests.

I know I don't need to say anything about diet because you already know all that stuff.

Good luck with whatever you try.
 
Thanks, Gayle. Cami's lactulose dose is currently 1ml bid (down from 3ml bid). Her miralax is 1/2 tsp bid. She gets cisapride, currently at 5mg bid. And pumpkin ~ 1/2 to 3/4 tsp a day.

She had a series of xrays in March that included her chest and I think both vets said her heart looked normal, but the ER vet detected a murmur. That could have been from severe dehydration because it was not there on followup. All of her abdominal organs are enlarged (liver, kidneys, intestines, colon and, I think, pancreas). The specialist said that was from inflammation. This was on xray and ultrasound. They were still enlarged after 2 months of pred and baytril, but her labs were better - all liver values normal when they were elevated before.

I guess you are right, I just have to keep raising the dose every 3 days until I get some response.
 
Ask the vet about dropping the lactulose and upping the cisapride.... Ollie gets 7.5mg cisapride.

What about B12 shots? Are you giving them? Weekly shots helped Shadoe with her inflammation issues.... just a thought .

ETA what about Senokot to help soften the stool?
 
I will ask about upping the cisapride, but that has a different action than the stool softener whereas Miralax seems to be the best swap out for lactulose.

I looked up the senokot from your link and it seems like a drug with a lot of side effects. They all do, but I'd rather get her on Miralax as the only one - and pumpkin. Not sure how that effects her BG.

She did drop better today - got a 127 at +8 (yay!), but then she was back in the 300s at PS. (boo).
 
Forgot to answer the B12 ? - yes, she gets B12 shots .25ml, which was happening weekly, but I slacked off with all the other stuff she is getting.

Thanks for the reminder, I gave it to her this am (Beau also gets it).

A a decent PS of 250 this morning. Holding 1.5u
 
That's good. ... glad you are giving the B12.

Everything seems to have side effects these days, so all you can do is juggle around with the dosing of your own combo and see what works best for you.

I hope everything settles nicely soon.

Gayle
 
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