Desperate for help!! Grim prognosis for diab + pancreatitis?

[Ashley Merrill]

Hello all,
My Wesley is currently at the vet after just being diagnosed formally with diabetes, along with his chronic pancreatitis. The vet gave him a very grim prognosis, and based on some of what I have read in this group I’m very confused. To make a long story short, he has been hospitalized twice in 6 weeks for pancreatitis, and after his appetite decreased this week (mirtazapine stopped working) his internist said we are at the point where we need to start insulin. He told me that pancreatitis and diabetes are two diseases that work against each other and are very difficult to manage, and that usually managing them is unsuccessful as the cats just decline.
With Wesley, he had his first pancreatitis flare last year, and then two since this January, so the vet thinks he’s already declining. At home he has great days and weeks, and then some not so great ones (the flares), but the vet is making it sound like managing both diseases is a total exercise in futility, as “most cats don’t get healthy again, it’s possible but unlikely.” He said he thinks we will just keep ending up hospitalizing him with severe pancreatitis flare ups, and he will continue to lose quality of life. He also said part of the big issue with these diseases is that pancreatitis makes him lose his appetite, but he needs an appetite for the insulin. I’m so confused and devastated to hear all of this.
The plan is to start him on a low dose of Lantus, and he said we don’t need to monitor his BS, just do urine testing for ketones - not sure of the insuline dose or exact plan yet as we are picking Wesley up and ironing it out later today.
I’m wondering what the general consensus is on managing these concurrent diseases? I was shocked to hear such a grim prognosis. Also, this is our “second opinion” of sorts... Wesley’s regular internist is on medical leave, but she consulted with this doctor about Wesley and he is managing his care until the regular internist is back.
Im sorry this is SO long, but I’m panicking here and I feel like I’m going to lose my boy Please help if you can.

 

[Idjit's mom]

Ashley, I am so sorry to hear that you are in such difficulty and I can certainly understand your confusion. I am not an experienced member here, but there are members who are experienced in dealing with both diabetes and pancreatitis. I do know, however, that testing is a must, especially if you are going to begin insulin therapy. You don't have to have anyone's permission to do so, and it's the best way to keep Wesley safe, hopefully to prevent any Hypos and to track how the insulin is affecting him.
Here is a link on Pancreatitis that might help shed some light: http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/
Also some information about ketones: http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/
I am sorry can't offer any advice, but I offer you huge hugs, and my support while you deal with these issues. Remember to breathe, calm yourself as much as you can so that you can take in the information, and I know that wiser and more knowledgeable people will be able to offer you input based on their experience.

 

[Kris & Teasel]

@Djamila has a lot of experience managing both. The essentials for getting through a flare of pancreatitis are: meds for nausea (Cerenia and/or ondansetron), meds to stimulate appetite (mirtazapine or cyproheptadine - start first with antinausea meds, then add in these if needed), pain meds (buprenorphine) and possibly subQ fluids at home. You can only manage symptoms, not the pancreatic inflammation itself.

Was a fructosamine test done to verify the diabetes diagnosis? If so and it was positive then starting insulin ASAP is important. A good starting dose of Lantus is a 1 unit dose given twice a day 12 hours apart. I disagree about BG testing. By testing at home you'll see if the planned dose is safe, how Wesley is handling the insulin and whether a dose is effective.

Urine ketone testing is a very wise precaution when a kitty is ill. Here are some ways to get it done:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

[Ashley Merrill]

@Djamila has a lot of experience managing both. The essentials for getting through a flare of pancreatitis are: meds for nausea (Cerenia and/or ondansetron), meds to stimulate appetite (mirtazapine or cyproheptadine - start first with antinausea meds, then add in these if needed), pain meds (buprenorphine) and possibly subQ fluids at home. You can only manage symptoms, not the pancreatic inflammation itself.

Was a fructosamine test done to verify the diabetes diagnosis? If so and it was positive then starting insulin ASAP is important. A good starting dose of Lantus is a 1 unit dose given twice a day 12 hours apart. I disagree about BG testing. By testing at home you'll see if the planned dose is safe, how Wesley is handling the insulin and whether a dose is effective.

Urine ketone testing is a very wise precaution when a kitty is ill. Here are some ways to get it done:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

@Kris & Teasel
Thank you for the reply. We are actually using all of the pancreatitis meds + fluids listed above for all of his flares, with the exception of cyproheptadine - I will ask about that one today, as the mirtazapine hasn’t worked this past week. The problem is that he has had 2 big flares in 6 weeks, and while he generally snaps out of the quickly with our med protocol, this time he is still not wanting to eat/or is taking an hour to finish his plate. Also, this last flare up (last week) landed him in the hospital despite us doing everything we typically do. Maybe that is this vet’s concern and the cause for the grim prognosis?

To answer your other question, they did do the fructosamine test last week and he was in the high 500s - 580 I believe. I think the ER vet thought this was just a transient problem so she did not start insulin. That seems to be a big part of this challenge, how to know if he is a “true diabetic” or it just happens with his pancreatitis flare ups, but either way it sounds like starting insulin is the right approach.
For the BG testing - how often would you recommend I do that? I assume I need to ask his vet how to interpret the results of the test.
Also, How often would you do the ketone test? Thank you again for being so helpful!

 

[Ashley Merrill]

Ashley, I am so sorry to hear that you are in such difficulty and I can certainly understand your confusion. I am not an experienced member here, but there are members who are experienced in dealing with both diabetes and pancreatitis. I do know, however, that testing is a must, especially if you are going to begin insulin therapy. You don't have to have anyone's permission to do so, and it's the best way to keep Wesley safe, hopefully to prevent any Hypos and to track how the insulin is affecting him.
Here is a link on Pancreatitis that might help shed some light: http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/
Also some information about ketones: http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/
I am sorry can't offer any advice, but I offer you huge hugs, and my support while you deal with these issues. Remember to breathe, calm yourself as much as you can so that you can take in the information, and I know that wiser and more knowledgeable people will be able to offer you input based on their experience.

Thank you for the links and your kind words of support! It means so much to have a group who understands this so well

 

[Idjit's mom]

Thank you for the links and your kind words of support! It means so much to have a group who understands this so well

I wish I could do more, but I can provide you with some links that will help others help you:
1. Set up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) You can edit this information at any time.
2. Another thing that will help us help you is to set up a spreadsheet like the one we use here to record insulin injections time/dosage and the BG tests you will be getting. Members will be able to see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
You are going to be busy when you bring Wesley home from the vet, so if you have time now to get the signature and spreadsheet done, you won't have to be concerned about it later. Best wishes!

 

[billysmom (GA)]

When my cat was having problems with pancreatitis, B12 injections really kick started his appetite. If there is concern that his pancreatitis flares may be affect his BG numbers, then it is even important that you monitor his glucose levels since his insulin needs may vary even more than normal. It really is the best way to keep your kitty safe.

 

[Asiina & Alex(GA)]

For the BG testing - how often would you recommend I do that? I assume I need to ask his vet how to interpret the results of the test.

You'll want to do it at least 3 times a day. Once before you give him his shot of insulin to make sure he's not too low to give the shot, and then at least once in the middle of the day to find his nadir (low point) and so you know if you're giving him the right dose. You'll need to experiment to find out where his nadir is, it depends on the cat and the insulin, so it can take some time to find but it's the best way to make sure you're dosing right.

You can keep your vet informed, but the people here can help you interpret the results and you'll learn soon enough how to understand them yourself.

Once you set up your signature, as others have said, it'll make tracking easier and others can help you.

 

[Tracey&Jones (GA)]

Hi there. Jones had chronic pancreatitis. It isn't easy to balance both of these things but doable.

For Jones I found the cyproheptadine - his dose split in half and given twice a day was the best way to get him to eat consistently versus only once day and a lot better than the mirtz! Off course, getting the naseau under control is required first before giving the appy stimulants. Jones did well on the cerenia so I never used the ondansetron. I also found later on when it was more like chronic pancreatitis that the buprenorphine twice a day to keep the pain down was very beneficial, we ended up at 3 times a day in the end.

Bone broth - you can make your own. I just bought the back and neck bone stock packages of chicken - added some water and boiled it. He enjoyed that and it seemed to help sooth the tummy without being heavy.

 

[Kris & Teasel]

Here's a basic testing routine:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

I recommend testing for ketones daily for now.

 

[Djamila]

Hi again, Ashley - This is all a lot to manage, but it is doable. And while it really really stinks when our panc kitties are having a flare, in between those their QOL is high and you'd never know there was anything wrong. You've already got a lot going as far as the meds for panc, but I would add one more: CBD is quite effective in treating pancreatitis in many cats. It helps with nausea, appetite, and pain all at the same time. And anecdotally, many of us who use it find the flares lessen in severity, frequency, and duration if we either use it daily no matter what, or start it immediately at the first sign of trouble.

I would also second the suggestion of B vitamin supplements - those have been super helpful for my kitty. And learning to do Sub-Q fluids at home can also be important if your cat goes off food and gets dehydrated with his flares. Lots of folks do it at home so they don't need to hospitalize.

The other thing I've found helpful is making quick adjustments to the insulin. When Sam is having a panc flare his BG numbers go up and he doesn't respond as well to the insulin. If I dawdle to increase, it's worse, and the higher numbers make him feel even more poorly than he already does. As soon as I get a whiff of a panc flare I start the insulin increases to try to stay on top of the BG rise. If you're going to go on Lantus, I would make sure folks know that you may need to adjust the dosing "rules" to be able to respond more quickly to those rises in BG. It can be done, even on Lantus, but folks who haven't experienced both may not be as familiar with that. And on Lantus, you'll need to be a little more careful as the flare clears and the dose needs to come back down. The longer overlap on Lantus could make that a little trickier, but there are folks there who can help you manage it as long as you're monitoring the BG at home. You don't need to understand all of that right now - there are people in the Lantus forum who can help you out.

 

[Bron and Sheba (GA)]

I agree with what the others have said about pancreatitis and the treatments.
Sheba was diabetic and had pancreatic flares. Sometimes they were close together and sometimes they were 6 months apart. But inbetween she was absolutely fine. Getting on to it early and having the meds at home to start treatment was the key.
Also I agree with home testing.
You will find wonderful support and help here.

 

[Ashley Merrill]

Hi again, Ashley - This is all a lot to manage, but it is doable. And while it really really stinks when our panc kitties are having a flare, in between those their QOL is high and you'd never know there was anything wrong. You've already got a lot going as far as the meds for panc, but I would add one more: CBD is quite effective in treating pancreatitis in many cats. It helps with nausea, appetite, and pain all at the same time. And anecdotally, many of us who use it find the flares lessen in severity, frequency, and duration if we either use it daily no matter what, or start it immediately at the first sign of trouble.

I would also second the suggestion of B vitamin supplements - those have been super helpful for my kitty. And learning to do Sub-Q fluids at home can also be important if your cat goes off food and gets dehydrated with his flares. Lots of folks do it at home so they don't need to hospitalize.

The other thing I've found helpful is making quick adjustments to the insulin. When Sam is having a panc flare his BG numbers go up and he doesn't respond as well to the insulin. If I dawdle to increase, it's worse, and the higher numbers make him feel even more poorly than he already does. As soon as I get a whiff of a panc flare I start the insulin increases to try to stay on top of the BG rise. If you're going to go on Lantus, I would make sure folks know that you may need to adjust the dosing "rules" to be able to respond more quickly to those rises in BG. It can be done, even on Lantus, but folks who haven't experienced both may not be as familiar with that. And on Lantus, you'll need to be a little more careful as the flare clears and the dose needs to come back down. The longer overlap on Lantus could make that a little trickier, but there are folks there who can help you manage it as long as you're monitoring the BG at home. You don't need to understand all of that right now - there are people in the Lantus forum who can help you out.

@Djamila A holistic vet did recommend CBD to me, which of course his internist turned his nose up at. I read online that it may interfere with some medications (like prednisolone), so I’m wondering if that should be a concern. May i ask what brand you use and have you heard of any medication reactions?
I do use B-12 and we are doing daily SQ fluids - it sounds like we are on the right track from what you’ve shared, so yay!
Wesley just started the Lantus yesterday at 1 unit once daily. The vet said at this point he is not trying to control the diabetes, but to “feed the cells” and try to heal the pancreas as he feels that the pancreatitis and diabetes are feeding each other. He recommended at such a low dose I don’t home test, just see if it helps keep him out of another flare up, and he wants to test fructosamine again in 2 weeks. From there we can adjust as needed. Just crossing my fingers that this little bit of insulin will be what gets him more “normalized.”
I’m sorry if I asked you this already in another post, but do you have an opinion on whether or not fat content in food matters for a cat with chronic pancreatitis? I’m hearing very conflicting things, and my top 2 food choices for him (Rawz and Ziwi Peak) are both low carb and like 57% fat.

 

[Ashley Merrill]

I agree with what the others have said about pancreatitis and the treatments.
Sheba was diabetic and had pancreatic flares. Sometimes they were close together and sometimes they were 6 months apart. But inbetween she was absolutely fine. Getting on to it early and having the meds at home to start treatment was the key.
Also I agree with home testing.
You will find wonderful support and help here.

@Bron and Sheba Thank you! This group has been an incredible resource so far!

 

[Ashley Merrill]

When my cat was having problems with pancreatitis, B12 injections really kick started his appetite. If there is concern that his pancreatitis flares may be affect his BG numbers, then it is even important that you monitor his glucose levels since his insulin needs may vary even more than normal. It really is the best way to keep your kitty safe.

@billysmom (GA) We are also using B12, so fingers crossed. Thank you!

 

[Ashley Merrill]

Hi there. Jones had chronic pancreatitis. It isn't easy to balance both of these things but doable.

For Jones I found the cyproheptadine - his dose split in half and given twice a day was the best way to get him to eat consistently versus only once day and a lot better than the mirtz! Off course, getting the naseau under control is required first before giving the appy stimulants. Jones did well on the cerenia so I never used the ondansetron. I also found later on when it was more like chronic pancreatitis that the buprenorphine twice a day to keep the pain down was very beneficial, we ended up at 3 times a day in the end.

Bone broth - you can make your own. I just bought the back and neck bone stock packages of chicken - added some water and boiled it. He enjoyed that and it seemed to help sooth the tummy without being heavy.

@Tracey&Jones- GA Hi again! I’m sorry if I asked you this before (I’m very overwhelmed), but do you have an opinion on if fat content in food matters in a kitty with chronic pancreatitis? I’m getting mixed messages from different vets, and the 2 foods I’m most excited about (Rawz and Ziwi Peak) are low carb (4-7%) but higher fat (55-60%). It’s all so confusing!

 

[Tracey&Jones (GA)]

Hi Ashley....neither Jones' regular vet or IM specialty vet ever mentioned fat content with me.

He was on Rawz Turkey for a very long time and it worked for him and his pancreatic flares were not really that bad until the very end and even then it was hard to say what was up with the IBD issues at play.