Diabetes and pancreatitis

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Priss

Priss

Member Since 2012
Priss's ultrasound showed abnormal pancreas so she will be treated for pancreatitis when she gets home from the hospital. I was wondering if anyone here has some experience managing both. I can't afford the hospital again so want to be sure I can take care of her well at home. I'm concerned about this because the vet says the treatment is supportive care only, from what I read it is painful, I'm worried about her quality of life.
 
It is painful, and thats why a key to recovery is PAIN MEDS! Its a vicious cycle, cat is in pain doesnt want to eat, if they do eat, they are in pain, and dont want to eat...

This was a post by a former poster, a vet tech. Its on the old board.
http://www.felinediabetes.com/phorum5/r ... 722,876722

edited to add that pancreatitis is very common among diabetic cats, and its sometimes diabetes that triggers pancreatitis, and sometimes pancreatitis damages the pancreas and causes diabetes.

Sending cyber hugs to you both.
 
There are many of us with acromegaly cats who have diabetes that deal with pancreatitis. Because of the high expense taking care of our cats we do a lot of the care for them at home.

Yes fPLI are THE diagnostic tool for pancreatitis but truthfully the care for it is the same regardless of the number that comes back.

Subq fluids are a BIG help. Are you able to do this yourself at home? If you are giving insulin you would be able to learn this. Typically if you give them everyday for awhile this helps a lot! You can go to your vet and get a bag of fluids/tubing/needles and you are set to do this at home. This will save you money!

Pain meds such as buprenex are also given. Doses vary but this too is also given usually bid or tid (2 or 3x/day). It's a compounded narcotic.

Pepcid AC - 1/4 tab given bid will help with nausea related to the panceatitis. It's a med bought over the counter. Make sure it's the pepcid AC NOT complete

And then try to keep your kitty eating. That's a big one. Anything - yes canned food is perfect BUT if they won't eat - try anything. lunch meat, boiled chicken, some people swear by kentucky fried chicken, even dried food if that's what your kitty will eat. Just keep them eating. One of my kitties, a civie with triaditis which includes the pancreas, went thru this and when I was off work I would offer food every couple hours and even if he just licked a spoon full I was happy.

I hope this helps. Let me know if you have any questions!

Wishing you and your kitty the very best!
 
My Shadoe had frequent problems with pancreatitis.

I was giving her Pepcid AC BID.... the maximun daily allowed for cats is 5mg, to get the regular strength 10mg and cut in quarters. The pepcid helped her a great deal but I also needed to give her fluids and pain meds fairly often.

I always kept fluids on hand because you never know when a flare will happen.
Watch for the signs and sometimes the fluids can help plus a bit of pain meds.

I know that buprenex is most common used, but my first vet gave me a transdermal gel pain med to rub on the inside of Shadoe's ear. She hated it but my other cat just LOVED to lick the stuff off the inside of Shadoe's ear! The gel seemed to work well on both cats, but I switched to bupe as it did work better. Ask any human who has had pancreatitis and they will tell you it's extremely painful, so tell your vet you want a pain med that's fast acting like buprenorphine/buprenex.... other meds like tramadol or gabapentin are good pain meds but not for pancreatitis..

The fluids are easy to give; you are already giving insulin shots, so it's really just another needle, but it's got a line and a bag connected to the needle. Way cheaper on your wallet, and eliminates the stress on your cat to have to be transported to your vet office.

Now, I was forever having to deal with Shadoe's flares until I changed to a better vet. As soon as I described her attacks, the pain just touching her sides, meatloafing, not eating, etc, the vet smiled, and said, 'B12 shots'. I got a bottle of B12 from him and began giving her weekly shots of 25u B12.
Within a month, after 4 shots, she was a great deal better, and she had only one minor incident in the months that followed. Shadoe was so much better that I started giving the shots to Oliver as well as he was prone to low grade pancreatitis as well. Please note that B12 is good for many other issues, and is a great antioxidant.

The B12 helps with the inflammation of the pancreas, so if there was alot of inflammation in the u/s, tell your vet you want to start giving B12 shots.
 
We asked for pain medication and the vet said that the less expensive one wasn't good since she would get lethargic. The vet didn't think she was in pain since they palpated her abdomen. I asked for a prescription for the better one anyways, but don't have it yet so we can try Costco.

Priss just came home and is hiding in her carrier, I think after all these vet visits she has actually come to like it.

The fluids I gave to her before so can handle that OK.
 
Supportive care is the key with pancreatitis. Pain management and hydration are very important. Normally Vandow gets zofran twice a day, pepcid once a day, pred every other day, flagyl once a day, and his heart medicine once a day. When his appetite starts to decrease I usually do subq fluids 100ml a day. On occasion I also will give him subq buprene twice a day. In the last two years I have become pretty good at managing his pancreatits. I can pretty much get him back on track before he gets a chance to tank. The pred and flagyl are not necessary for pancreatitis. You may read conflicting views on using pred for pancreatitis. With a diabetic kitty I would not use unless it was absolutely necessary. Vandow also has IBD and the pred and flagyl are primarily for that. He also has asthma and the pred helps with that. Vandow is not diabetic. When he first got really sick I almost got him a feeding tube. Luckily he started to eat on his own. Vandow never fully recovered from his pancreatitis. He had one awful acute attack. He has chronic pancreatitis with acute flare ups. I try to keep on top of it. A few times a week lately I'll give him cyproheptadine as well with good results. Sometimes I also give him cerenia too. I find the zofran is good for nausea. Vandow will throw up on occasion and that is when I give him the cerenia. Zofran and cerenia work differently in treating nausea. There is a really good yahoo support group for feline pancreatitis.

Sandy
 
Priss said:
We asked for pain medication and the vet said that the less expensive one wasn't good since she would get lethargic. The vet didn't think she was in pain since they palpated her abdomen. I asked for a prescription for the better one anyways, but don't have it yet so we can try Costco.

Priss just came home and is hiding in her carrier, I think after all these vet visits she has actually come to like it.

The fluids I gave to her before so can handle that OK.
Click to expand...

Pancreatitis is painful.... if YOU were in pain, would you like to be alert and suffering, or would you like a little something to ease the pain while you heal.
I am sadly not surprised that a vet 'doesn't think she was in pain'.
Contact the vet and say that you want pain meds. Don't accept NO for an answer.

To say that the cat has no pain because the abdomen was palpated is ridiculous; cats are very good at hiding pain and they can be very stoic.

One of my cats tested positive for pancreatitis and had no visible signs. I treated him and he looked visibly relaxed, as in out of pain, when given pain meds.
My small cat could handle triple the amount of pain meds as he could, but he was 3 times her weight; every cat is different, but pancreatitis is always painful.

If you give the pepcid, it will settle any upset stomach and make eating easier for your cat.
The fluids will help to flush out toxins, hydrate, and will help to bring down BG numbers.
The pain meds will give your cat comfort while the inflammation of the pancreas can settle.

one of many links to info on the condition..... do not accept metacam as pain med. Buprenex is best.
http://www.allfelinehospital.com/site/v ... atitis.pml
 
I'll try and get the prescription again. I know they didn't want to prescribe the one starting with a Z because it sedates her.
 
One of the nurses is checking for me. Wow it is expensive they say $90 for three days worth and it comes in a dose syringe which degrades after 3 days.
 
Priss said:
I'll try and get the prescription again. I know they didn't want to prescribe the one starting with a Z because it sedates her.
Click to expand...

I don't know any med for pain starting with a 'Z'. Just so long as you don't get any meloxicam/metacam as it's harmful to cats and should be used almost like a last resort for cats.
You don't want something that is going to knock her out, but you do want something to numb the pain.
If you have ever had some sort of bad pain, can you imagine having that pain for days with no relief?
I will say that I never gave the full dose to Oliver because just the smallest amount was enough for him, but Shadoe needed the full dose for her weight.
Buprenex does not go bad and it's a very good tool to have on hand because cats with pancreatitis are quite likely to have more flares in the future, and keeping bupe, pepcid, and fluids on hand will be important to keep your cat well.

here's a list of some....


http://www.veterinarypartner.com/Conten ... &C=299&S=2

the buprenex does not go bad in 3 days. What med is the nurse saying costs that much money? Can you ask the name of it? That's a crazy price! You do not need to get the buprenex in prefilled syringes; they can put the liquid in a bottle and you can draw out the amount you need.

Be sure to check for any interactions if she is getting any other meds.
http://www.drugs.com/drug_interactions.php
 
If you are talking about the Zofran - that is for nausea. I would try the pepcid AC first - you don't have to go with zofran initially. See if the pepcid helps enough.

Buprenex is the pain med. I've gotten it from a compounding pharmacy where I live. 10ml is about $40. And my kitty only needed 0.1-0.2ml once to 3x/day.

IF you needed to get buprenex more regularly - diamondback meds has a better price for it but it takes several days to get it
 
I called and the overnight nurse was able to get the prescription for us. It turned out to be $42 after being scaled down for her weight. I'm sure that's a premium but didn't want to wait any longer. Tramadole (sp?) was the drug she didn't want to prescribe.

This pain medication is buprenorphine, not sure if it is the same as buprenex?

I just gave her one does and now saw some things on the internet it is bad for kidney disease, she had some kidney disease shown on the ultrasound. Just called the vet back and asked about that - they probably are sick of my calls.
 
All the medication came from the same vet:

Mirtzapine appetite stimulant
Cerenia anti nausea
Denamarin liver support
Baaytril antibiotic
Tumil K Potassium supplement

I didn't think to double check about interactions, will look it up
 
Thanks Blue,

It did show an moderate interaction with the appetite stimulant. I'll have to ask the vet about it before giving again - luckily last dose of that was over a day ago.

Interactions between your selected drugs


buprenorphine ↔ mirtazapine
Applies to:buprenorphine and mirtazapine
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Switch to consumer interaction data
 
On the Buprenex: My vet wrote to give 0.10cc twice a day or as needed. I tried giving J.D. half of that 0.05cc and it made him very very wobbily, so I ended up giving him half of that 0.025cc and that seemed to be a better dose for him. Priss may react differently ECID.

The first time I got it, J.D. was limping from a miss jump off my desk, and they gave it to me in the prefilled syringes and I found those harder to administer and harder to adjust the dose.

When J.D. was dx with Pancreatitis they gave me a vial (small glass jar with a rubber stopper) with a little of the medicine inside, and I was/am to use a syringe (which they gave me a certain one to use that is bigger and probably numbered or marked differently than an insulin syringe) to draw the dose out of the vial, take off the needle, and then give the medicine to J.D. by mouth in the side of his cheek.
 
Buprenorphine and buprenex are the same thing. aka "bupe"

Yes usually there is no problem giving "bupe" and mirtazapine together. I've used the 2 together on 3 of my cats and not had an issue but then every cat is different too.

How often are you giving the cerenia? It's a bit more costly? It's certainly a wonderful med but it would be worth your while to have some pepcid AC in your cupboard just to have on hand all the time for those "off times" your kitty isn't feeling the greatest. Also pepcid AC and cerenia can be given together if one or the other alone isn't doing the job.


Why is your kitty on potassium? Is the level low? This can cause nausea?

And the Baytril? usually they give Amoxicillin if they are going to treat pancreatitis with an antibiotic. Baytril has side effects that they tend not to use this right off hand. Also if they add in another antibiotic it's flagy (metronidazole)
 
The paind medicine doesn't seem to make her any more wobbily than she already is. She hasn't eaten on her own yet although she did a little in the hospital. I'm thinking of trying to find a place that can do the etube again if we can. They asked that I keep her on Baytril because of her kidneys. She is taking both pepcid and Cerenia. The potassium level is low, it was since last week when I had her lab done and she was still moving around OK. I just checked again with the doctor and they said the same thing, that its OK to give the bupe with the miratzapine, that they do it all the time. Maybe the website is more for humans.
 
What kind of food are you using to syringe feed her?
I just got back from a vacation in California and was able to score a case of IAMS MaxCal (Maximum Calorie) that I haven't been able to find in New Jersey. MaxCal is low in carbs and has 330 calories per can.
Maybe, the potassium level could be off from the ketones. I would try to get as many calories into her as you can. Plus fluids, and keep her BGs as best under control as you can. An etube would make feeding a whole lot easier.
 
Is she eating anything on her own? it doesn't have to be cat food? even if it's just a lick or 2? have you tried the foods in gravy? does she still have ketones in her urine? And may I ask how much subq fluids are you giving at a time?

I hope you don't mind me asking so much.

FWIW - I went thru a lot with one of my cats as I mentioned before and I so feel for you. Simba's liver tests were sky hi (in the 1000's) and we went thru so much with him. And this is just an aside but i'm a pediatric ICU nurse and kids and cats are so alike. If I can help at all with everything Simba taught us - I'd love to pass that on.

Sending good wishes to both of you
 
She ate at her own twice at the hospital a small amount but not even a lick here. Not even water or anything she usually likes. I haven't tried the foods in gravy. Before the hospital the ketones were the darkest color, yesterday moderate, and this morning between moderate and small, hopefully that is a good sign. The vet said 100ml twice a day for the fluids. I tink I have a written prescription for maxcal from last time she was sick, maybe they can still fill it since it was only 3 months ago.We're in California also and one or two vets carried it but were all out.
 
Have you tried any tuna, tuna water, canned chicken, lunchmeat (ham, roast beef,) laughing cow cheese, boiled or cooked chicken, or even dry food. Also purina appetizers sometimes are liked
 
We tried chicken and dry food. She ate dry food at the vet. I have some tuna so will try that
 
Good news - she ate some dry food on her own! Last night I got some of the maximum calorie Iams food to syringe feed her, the 330 calorie/ can food, and it seemed to help! This morning she ate all the food we had left in a bowl trying to get her to eat (it as the same she ate at the vet).
 
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