Diabetes following Pancreatitis - New Member

[Tisha's_Person]

Hello all! My name is Lisa. We rescued an all black cat named Tisha (short for Morticia - named by previous owners) about 2 years ago. After we adopted her, we found out that she was returned by 2 previous owners for litter box avoidance issues. I'm kind of stubborn, so we decided that we were going to conquer this issue. We've tried just about everything (new box, more boxes, new location, calming collar, prescription food, etc.) She seemed to go through cycles where she would do better, followed by a return to problems everywhere. Most distressing to my husband, when she really wants our attention, she pees on his side of the bed while we are asleep. This summer, we had a bout of what looked like yet another recurrence of litter box avoidance. We did a urine sample at home and the vet was surprised that her sugar was high because she's only 5 and not overweight. She asked us to retest in about 1 week. Before we got there, Tisha got really sick, was vomiting everywhere and lying in a corner sounding pitiful. Needless to say, that warranted an emergency trip to the vet, who stayed late to see her that day. She was diagnosed with pancreatitis, and the vet said that she thinks her ongoing problems may have been mild chronic pancreatitis in addition to struvite crystals in her bladder. After 10 days on antibiotics, she seemed to feel better, but was still avoiding the litter box. We did another sample and her sugar was high enough to get a call to bring her in. She was diagnosed as diabetic (with a blood sugar around 451) and placed on Lantus insulin on 7/19. Now, 2 weeks later, we did our first blood glucose curve and her BG is still ranging from 250-380, which I think is still way too high. Meanwhile, the cat is down from 12 pounds to 10, and we have 5 (yes, I said 5) litter boxes spread throughout our house with puppy pads everywhere. Any words of advice or suggestions? Anyone else who has been through diabetes with such a young cat following pancreatitis? She has NO risk factors for diabetes.

 

[BJM]

Welcome to FDMB.

Before we can answer your questions:
What are you feeding her?
What was the starting dose of Lantus?
How big were any dose increases?
Are you checking her blood glucose at home?

 

[BJM]

Marje & Gracie's 'Primer on Pancreatitis' here may be helpful.

We recommend home glucose testing with an inexpensive human glucometer, matching test
strips, and 26-28 gauge lancets to get a small droplet of blood from the outer edge of the ear (between the vein and the edge).

Once you get the knack of home testing, you may find that adjusting the diet to 100% low carb, canned, over the counter food may drop the insulin dose by 2 units and may lower the glucose level about 100 mg/dL, although each cat is different. We want you home testing first, so you can do this safely. Cat Info explains more about appropriate feline nutrition (written by veterinarian, Dr Lisa Pierson). Do the diet changes about 20-25% different food each day to minimize GI upset and to allow insulin adjustments as needed.

 

[Tisha's_Person]

We are testing blood glucose at home using the One Touch Ultra Mini, but we just started that this weekend. (Poor Tisha's ears looked pretty pitiful at the end of the day. I tried to have my husband help me and he is color blind, so he was having trouble seeing where the blood was against her black fur. As a result, even when I got a good drop of blood, it would get smeared and we would have to start over. I asked one of our teenagers to help instead.)

Tisha started the Lantus insulin at one unit 2 weeks ago. The vet does not like to change doses with less than 2 weeks to allow her body to adjust to the new dose. I have sent the blood glucose curve to the vet by e-mail, but I don't have a response yet. She has been on a prescription diet for the struvite crystals for about 6 months, so we have been transitioning her dry food to the diabetic food the vet prescribed, which is available for free feeding. She gets 1/2 can of Fancy Feast classic canned food before each shot. (1/2 can is really all that she will eat.)

We used to give her canned food every night and she just quit eating it. She seems to prefer dry food, and she really needs to gain some weight back. When we started the canned food with the insulin, she was super excited to get it and ate it all. We have continued with the same food, same flavor in the hopes that she will continue to eat it. While she is still meowing at us when we open the can and runs over to the food dish, she eats a few bites and then stops. So far, we've been able to coax her into eating enough to give her the insulin (2 Tbsp per the vet), but I am concerned that we may eventually get to a point where she doesn't eat enough to get the shot. Then what do we do?

If you really want to know, I have attached her curve results. The first column and chart shows blood sugar. The second set of times shows feeding and shots.

Thanks,
Lisa

 

[Tisha's_Person]

Update: I just talked to the vet. We are increasing her dose to 2 units twice per day and will recheck her BG curve in 2 weeks.

 

[Critter Mom]

Hi Lisa,

My Saoirse is in the same boat as Tisha. :sad:

She has been on a prescription diet for the struvite crystals for about 6 months ...

This caught my eye. Was it the Royal Canin Urinary prescription diet by any chance?

 

[Tisha's_Person]

Okay, I got my time line wrong. In September, she was diagnosed with a bladder infection and suspicious for stones, so the vet put her on Hill's C/D. This spring (maybe as late as May), her urine sample still showed crystals, so the vet changed her to Royal Canin S/O. In June, her urine showed no crystals, but high sugar. That sample led to the bout with pancreatitis, followed by diabetes. The vet thinks what was diagnosed as a bladder infection was likely pancreatitis. (It was a different vet who originally diagnosed it without a good urine sample.)

 

[Tisha's_Person]

The new food is Royal Canin Diabetic.

 

[Critter Mom]

Thanks for that, Lisa. I had a reason for asking, because I think Saoirse's problems may be related to RC food.

Saoirse developed some calcium oxalate uroliths that had to be surgically removed a few years ago. She had been eating Iams dry kibble and from what I've learned over the last few weeks the so-called "urinary protection" in that food is what probably caused the formation of oxalate uroliths.

Saoirse was prescribed RC Urinary s/o after her surgery to prevent formation of further uroliths. Then she started putting on weight despite the fact that she has never been a big eater. I switched her to the RC urinary s/o moderate calorie formula, and subsequently to RC Obesity Management - all with tightly controlled portions, neither of which did much to produce weight loss. The poor darling has been hungry for the last 2 years! She also started overgrooming her tummy (behaviour that my previous vet regarded as perfectly normal for an older cat, and possibly boredom-related). That's why I didn't notice any pre-diabetic warnings until the PU/PD started.

It's only my opinion, but I firmly believe that the RC foods directly contributed to Saoirse's pancreatitis. I just thought I'd share my experience with you. (My thoughts about the big dry cat food manufacturers are not fit to print. I keep apologising to my beloved cat for trusting them instead of becoming a better-educated critter parent. :sad: )

You will get great advice about species-appropriate, healthy food here at FDMB.