Diabetes, chronic pancreatitis and IBD - meds and diet advise

JCcat

JCcat

New Member
Hi FDMB fam!

I've been using this site since Day1 my cat was diagnosed with diabetes (6 year ago) and everyone here has been extremely knowledgeable and helpful!

It's been a good stable 5 years since i found the right routine for my cat (a little bit bumpy the first year to figure out the right type of insulin, dosage, and a diet plan that worked for my cat). However, my cat had an acute pancreatitis attack in early July this year. We have been through everything: ER, fPL, fTLI, ultrasound, different vets, various types of pain meds, anti-nausea, antibiotics, sub-q fluid, appetite stimulant, diet change, b12 and all kind of enzyme supplements etc... After two months of diagnosis and treatments, he's now with:
  • Diabetes (prior condition)
  • Chronic pancreatitis - his fPL result came back last week still showing pancreatitis
  • IBD - ultrasound saw some part of the small intestinal wall was thickened
  • He got an UTI two weeks ago. Vet couldn't pick up any bacteria from his urine though, gave a shot of antibiotics and sent home. He drank crazy amount of water and went litter box like every other hours and finally, the symptoms seemed go away after a week (fingers crossed).
  • His kidney and liver seemed to be fine based on the recent bloodwork and ultrasound (1 month ago)
  • Ultrasound didn't pick up any cancerous concerns, though the thicken small intestinal wall could be a cancer in brewing, but vet didn't convince that's the main cause of his pancreatitis and chronic vomiting issue.
  • He doesn't have EPI, nor B12 / Folate deficiency based on the fTLI results, but i still feed him oral B12 supplement and OTC digestive enzymes occasionally just to give him extra boost.
  • He rarely diarrheas, only symptom is nauseous and vomiting
He's now on Lantus 4U BID (home test frequently and adjust dosage as needed based on his food intake. Never had keto so far), Gaba 25mg BID, Cerenia 1/4 pill every other day. Diet is usually Royal Canin Glucobalance / Science Diet MD / Purina DM wet+dry, mixing with small amount of fancy feast and some other low carb cans that I can get from shops, just to get him eating. He still vomits every 2-3 days, doesn't seem to be driven by specific food. His appetite is super good after vomiting and slowly declines in 2-3 days, getting to a point where he vomits, then perks up and eats super well for a couple days, then repeats the same cycle over and over again. The reduced dosage of Cerenia every other day seems help extending the gap to 2-3 days, otherwise he would probably vomits every 1-2 days.

Vets suggest 100mg Gaba BID and Cerenia "whenever needed" since he's already 15. I'm kind of at a loss now, pretty much choosing "drugging him everyday until his kidney/liver fails" or "let him be miserable half of the time but hopefully can do less damage to other organs" I desperately appreciate any advise and suggestions on long-term medications, diets, and caring tips. Here is a list of questions that I can think of:
  1. If you give daily medications to your chronic pancreatitis baby, what's the medication combo you use, at what dosage?
  2. Cerenia is super expensive (~$6/pill even on Chewy) and have a 5-day use limit. Do you have experience with Ondansetron? It's way cheaper but doesn't have the anti-inflammatory effect, also not sure if it can be used long-term?
  3. Any canned or dried foods that would work for Diabetes/Pancreatitis/IBD cat? My cat hates raw food nor freeze dried, tried all brands and forms, he'd snack on them but no way i can get him eating them everyday as main meals.
  4. The reason why i also asked about dried food option is that, my cat will vomit bile if eating wet food only. This has been the case since he's kid and i've seen multiple IM and no one could figure out why. And now if he has a bad appetite, dried food is the only thing he would eat, so this is my essential backup for his diet plan.
  5. This is the most difficult question to ask - How do I know "It's time to go"? It's extremely painful to see him going through the good-day/bad-day cycle so often. and he has been sleeping way more, walking way slower and more wobbly, losing weight/muscle due to inactivity, and generally looking tired all the time compared to 2 months ago. I don't think he's in deep pain with gaba, but he's definitely in some kind of discomfort/distress. His daily routine now is just eating/drinking, sleeping, and using litter box. I'm afraid I'm being selfish and keeping him with me while he's suffering.
Sorry for the lengthy post. Its been a roller coaster journey these couple months and I feel so grateful that there is a community like this where I can search for first-hand/real-life information and supports. Thanks everyone for reading till the end & Best wishes for all your sugar babies!

Best,

Jas
 

Attachments

  • 1.jpg
    1.jpg
    336.1 KB · Views: 11
Hello and welcome. I've had a few cats with pancreatitis and GI conditions. Ugh! BTW, you cannot diagnose IBD with just an ultrasound, you need to do a biopsy to differentiate from small cell lymphoma. Don't let SCL phrase worry you. The one snoozing on my couch has IBD and SCL, with the SCL in remission about 7 years now. But remission means diagnosing and treating.

The fact that Piggy is still vomiting means that either he has IBD and needs a food change (and/or a steroid) or has SCL. Have you every tried going with a novel protein diet for him? Common allergens are beef, fish and chicken. You could try him on a novel protein like lamb, rabbit, venison, etc and see if that does away with the vomiting. A good probiotic also helps. Visbiome is a good one made specifically for IBD. The Glycobalance, MD and dry DM are too high in carbs for a diabetic cat. Another option to consider is a cooked novel protein diet. You can get meal completers (like EZComplete) to cook and make your own if you find a meat protein that works.
With Neko, who also had CKD in the mix, I made a lot of her meals with a novel protein. But I also found some canned ones that worked for her.

My current kitty (non diabetic) with occasional p'titis, is on a steroid full time. Not ideal, but as low as dose as we can without her getting ileus. When she has a p'titis flair, I definitely go to ondanetron. Sometimes with Cerenia as well. Have you looked into maropitant, which is the generic (and cheaper) version of Cerenia? Dosing is based on weight of cat. What works for my current skinny IBD girl might not work for a cat called Piggy. 😆 There is. no 5 day limit to Cerenia, that is old school thinking. You can give Cerenia and ondansetron. Getting to a diet without allergens was also important.

For a diabetic kitty, budesonide (a steroid) can help with impacting blood sugars for some cats, thanking that was the way with Neko.

For the last question, these posts might help.
 
Wendy&Neko said:
Hello and welcome. I've had a few cats with pancreatitis and GI conditions. Ugh! BTW, you cannot diagnose IBD with just an ultrasound, you need to do a biopsy to differentiate from small cell lymphoma. Don't let SCL phrase worry you. The one snoozing on my couch has IBD and SCL, with the SCL in remission about 7 years now. But remission means diagnosing and treating.

The fact that Piggy is still vomiting means that either he has IBD and needs a food change (and/or a steroid) or has SCL. Have you every tried going with a novel protein diet for him? Common allergens are beef, fish and chicken. You could try him on a novel protein like lamb, rabbit, venison, etc and see if that does away with the vomiting. A good probiotic also helps. Visbiome is a good one made specifically for IBD. The Glycobalance, MD and dry DM are too high in carbs for a diabetic cat. Another option to consider is a cooked novel protein diet. You can get meal completers (like EZComplete) to cook and make your own if you find a meat protein that works.
With Neko, who also had CKD in the mix, I made a lot of her meals with a novel protein. But I also found some canned ones that worked for her.

My current kitty (non diabetic) with occasional p'titis, is on a steroid full time. Not ideal, but as low as dose as we can without her getting ileus. When she has a p'titis flair, I definitely go to ondanetron. Sometimes with Cerenia as well. Have you looked into maropitant, which is the generic (and cheaper) version of Cerenia? Dosing is based on weight of cat. What works for my current skinny IBD girl might not work for a cat called Piggy. 😆 There is. no 5 day limit to Cerenia, that is old school thinking. You can give Cerenia and ondansetron. Getting to a diet without allergens was also important.

For a diabetic kitty, budesonide (a steroid) can help with impacting blood sugars for some cats, thanking that was the way with Neko.

For the last question, these posts might help.
Click to expand...
Hi Wendy & Neko - Really appreciate the detailed responses!

I think my next try is novel protein diet, since surgical biopsy is unlike the option for Piggy. Piggy had a spinal stroke 4 years ago and two paws became paralyzed. Vets are very hesitant to do sedation and anesthesia on him since. The ultrasound he underwent last month, the vet had to fully anesthetized him since he's absolutely out of control out there. It took him a full 24-hour to recover from the anesthesia. I'm not comfortable to put him through this again.

Do you have any novel protein foods to recommend? Piggy is ok with rabbit, no on lamb and duck, haven't tried venison. What worries me is that a lot of limited ingredient diet out there are actually high on carbs because they contain pumpkin/pee/bean in it. Self cooking is not an option for me unfortunately due to my busy work schedule.

I'm fairly new to cat IBD and its associated symptoms. I personally have lactose intolerant and if I accidentally eat some, I will diarrhea within a few hours. Piggy rarely diarrhea, and his vomiting time seems to be quite random - sometimes everyday, sometimes every 2-3 days, same foods, same medications, but different outcomes. Does this sound like "food allergy" to you? Now you mentioned about SCL, I'm really worried that if his symptoms are trigger by the lymphoma.... I think I need to get ready for the next phase of diagnosis and treatment if diet change doesn't help.

In terms of probiotic, would you please give more suggestions? Piggy is super picky on the stuff I added to his meals, he will hungry strike on me if he dislikes the product. I usually get a few different brands just in case he doesn't approve the product.

I've tried the Cerenia generic, the price is $4/pill, still quite expensive since he needs 1/2 - 1 pill per day (he's a real piggy at 16lb, and this is his "sick" weight, he was at 18lb before the pancreatitis attack). I may need to ask vet for some Ondanetron just to offset the cost a little bit if i need to feed him everyday.

Last but not least, thanks for the posts for the "time to say goodbye" topic. I read through them (with tears in eyes) and I will keep those principles in mind. For now, I will just keep calm and carry on. Hopefully I will figure out a diet/medication plan that would keep him comfortable.

Thanks again for your responses!

Jas
 
A novel protein diet is a good way to test that it's only IBD. There are a few rabbit options. This food chart is a few years old, but a place to start. Just search for the word rabbit and check the carb%. Then you'll have to go to the manufacturers website and check out the ingredients list for foods that don't work. For example, Nature's Variety Instinct Rabbit regular has pork in it, which fortunately my IBD girl can eat. Their limited ingredient version has peas, but makes a good medium carb food. Rawz, Hounds and Gatos, Nature's Logic, Identity, Lotus are a few of the ones I've tried. It's not always the protein that is the issue, sometimes it is the other ingredients like gums. My girl doesn't do well with green lipped mussels. You'll have to make sure treats are also only rabbit.

Visbiome product is the most concentrated, so you'll need less volume than other probiotics. Proviable is another good product, you just need more of it. The vet might have some suggestions too. Note, Fortiflora is not a good product. You want multiple strains in the probiotic.

I get the maropitant compounded into a transdermal. It works out to about $1.33 per 4 mg. I have a much smaller cat. When you say $4 per pill, how large is the pill? Dosing is by weight of cat.
 
These two web sites have good information on treating IBD:

IBDKitties – Helping Save Lives…One Paw at a Time
Feline IBD - Healing can happen!

Koha LID canned is a good low carb option for diabetic / IBD cats. Rawz and Rayne are two others.

Some people who do home cooked or raw diets spend a day making up a big batch which is then frozen into individual or daily portion sizes.

I personally feed my diabetic / IBD / hot mess of a cat a commercial freeze dried raw food in rabbit. He's always eaten a commercial raw diet. His diabetes is caused by the steroid he needs for the IBD. For his daily snacks via the feeder, I give canned food.

Have you tried rehydrating freeze dried raw food first? It turns into a sort of chunky canned food texture which might be more appealing than dry pieces. Air dried raw is similar to dry food and many cats like that.
 
The Feline IBD site that Squeem3 linked discusses a raw diet. That may or may not be of interest to you. What is great on their webpage is the information on meds and supplements.

ZiwiPeak had a venison that I feed my IBD cat. It does contain mussels so if fish is an issue, it won't work.

ZiwiPeak also has an air dried raw line and Stella & Chewys has a freeze dried raw product.
 
You must log in or register to reply here.
Back
Top