Feb 1, New Member, Need help with Triaditis cat in pancreatic flare and newly diagnosed diabetic

Hello my name is Carolyn and my cat’s name is Oscar. He is an 11 year old that was diagnosed in April of 2020 with triaditis. We had come through a couple of years of chronic diarrhea and weight loss then his teeth got infected and caused an abscess. He was hospitalized on April 1st last year and had surgery to remove all but 3 of his teeth - the abscess persisted on the side of his face for a few weeks - kept draining and re-filling and Oscar became anemic. He eventually survived all that and was put on 10mg per day of prednisolone for the IBD. He has been up and down since - foods were tough as he also has some sensitivities or allergies that would cause flares. He gained weight slowly after surgery - he was only 5.2 lbs then (his healthy weight prior was 12 lbs) - up to 7.8 lbs about a month ago then he started losing weight again even though he was eating ok and getting 250 to 300 cal/day. The only food he likes and eats is fancy feast turkey and giblets.

About a month ago when he started losing weight (he’s now around 6.25 lbs) his fur was greasy looking. He had a full blood workup last Friday and fasted the night before. His test results came back as pancreatitis and diabetes.

We didnt get very much help from the vet. Just sent home last friday with syringes (u-40 1 ml), Caninsulin (40 I.U.) and told to give him 2 shots a day 1 unit each after eating. They said if we had access to a blood glucose tester great but if not to bring him back in a week. We gave him his first shot of insulin (dose 1 unit - 1 I.U.) saturday morning and within a few hours oscar became extremely lethargic, couldn’t walk - could barely hold his head up and seemed out of it. I called the vet they said he’s probably just beat out from the testing and gabapentin the day before and he’ll be fine. I was totally frightened and watched him closely. I kept offering him food and he ate little bits all day. He finally came almost back to himself by bedtime so we didnt do any more insulin that night.

I was referred to this board and have read all the articles - so helpful. I learned how to test his blood glucose and about his hypoglycemic event - I’m sure that’s what it was. We tested oscars blood glucose throughout the day Sunday and gave oscar his first insulin shot last evening.

On sunday His pre breakfast BG 11.3
Ate 1.5 cans of FF
+3 hour BG 18.5
+6 hour BG 15.4
Ate 3 - 1/4 can amounts throughout the day
No food 3 hours before supper
Pre supper BG 15.7
Supper was 1.5 cans FF
Gave him 1/2 unit shot of insulin
+2 hour BG 15.3
+4 hour BG 14.4
Fed him 1/2 can at +4 hour - normal bedtime food or he throws up due to empty stomach. I thought yay we kept his sugar from spiking after eating and then...

This morning I woke to poop outside the litter box - oscar pooped 3 times over night (he usually poops only 1 or 2 times) and they were all softish - no diahrrea tho so that was good - he peed on his bed twice which hardly EVER happens. He had a rough night I have no idea how bad. This morning he seemed weak and not himself and I checked his prebreakfast BG it was 20!! I was confident when i went to bed that we could manage this and now I’m scared again. I gave him 1/2 unit insulin shot this morning after he ate. I plan on checking BG at + 2 hours.

so now i need help:
I can’t feed oscar just two times a day to match 2 insulin shots due to his IBD - he throws up when his stomach is empty. He begs for food all through the day so i normally feed him 6am, 10 am, 2pm, 6 pm and 10 pm and that was working. He hasn’t thrown up for a long time.

Please, I need advice on how to manage the Triaditis/IBD, his pancreatitis and now insulin shots for his diabetes. What feeding/insulin schedule would you recommend?

Sorry for the long post but if I missed anything or you have questions please ask - I’m scared and overwhelmed.

 

I'm so glad you lowered the dose and that you are testing at home.

You don't have to feed twice a day, but with canisilun you do want to feed just before shot time. I feed four times a day. Just no food at least 2 hours prior to the preshot test so the number is not food influenced. One way you could do this is by getting a timed feeder that will close off access to the food before the morning. I feed at around 6 am, 12 pm, 6 pm, then before bed around 10 pm.

What are you feeding?

How are you treating the pancratitis?

 

One thing that would really help would be setting up a spreadsheet like the one you see in our signatures. Here's the how to link https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Another helpful thing would be to set up a signature with basic info. Click on your name at the top right corner and choose signature. Add info such as your pets name, date diagnosed, insulin type, food you're feeding and any health concerns and medications

 

Hello Janet... thankyou so very much for your reply. We are feeding Fancy Feast Turkey and Giblets wet food... he won't eat anything else currently. We were given low dose gabapentin for the pancreatitis (0.2ml twice a day - 50 mg/ml so it's 10 mg twice daily). Other than that we have just the insulin and prednisolone. I could definitely give that schedule you have a try with Oscar - I think that would work well. Do you give the insulin at the 6am and 6 pm only?

 

Sorry for the posting mistakes... I'm new and trying to figure things out lol... thankyou for the posting tips and the link for how to upload the spreadsheet. I am doing a manual graph so i will do this spreadsheet today and link it

 

HI! If your cat is having a pancreatitis flare, it's usually also treated with sub q fluids. When my cat Zimmy had panreatitis they gave him bupe for pain, cerenia for nausea, and we did daily sub q's. FF turkey is a great choice. Yes, insulin is only given twice a day.

 

If you need help with the spreadsheet let us know and someone can help you set it up.

 

Thanks again Janet!! I will reach out if I have trouble with the spreadsheet I promise. I wondered about the 'lack of treatment' for the pancreatitis - the vet called me this morning to check on Oscar and I asked about it - they told me he wasn't dehydrated but I told them i thought extra fluids were what helped the pancreas get better - they said they would get back to me. They said Oscar is a very complicated case. I do have some cerenia (i tablet that I am supposed to split into 4 pieces and give one piece a day) but I haven't given any yet - Oscar had a cerenia shot on Friday after his blood test - because of the fasting he was nauseous. He still seems to eat so I will continue to watch for signs that he is nauseous. I'm so glad you think the food choice is great... I'm a member of an IBD facebook group and a lot of people don't like the choice of FF classics - they don't believe it's nutritional enough - but it works for Oscar so I'm sticking with it for now. I don't want to change his food in the middle of all this trouble.

I have another question... my vet said this morning if I test oscar's blood sugar in the morning before eating if it's below 12 or 14 to not give a shot... is that a good idea? do I just skip that dose?

 

as long as he's eating enough on his own you can probably hold off on the cerenia but I'm glad you have some on hand. FF is low carb, and many cats do fine on it. My non diabetic cats eat it. My diabetic eats weruva foods because she has kidney problems and so needs a food lower in both carbs and phosphorous.

We usually tell new people not to shoot below 11. One thing you could do if you get something close to that is to stall without feeding for up to an hour to see if the number is coming up. Later when you have more data on the spreadsheet and generally know how your cat reacts to insulin you could dose lower.

 

Thanks again Janet... it really helps to talk to someone who has been through this. I'm curious why Oscar's BG was so high this morning. My son said he checked on Oscar around midnight last night and his food bowl was empty (the 10 pm 1/2 can feeding) and he was sitting by the water fountain. How and why would his sugar be at 20 just 7 hours later with no food? Is this normal?

 

It goes higher because the insulin wore off. Caninsulin is not a really long lasting insulin (it's made more for dogs who have a slower metabolism which is where it's name comes from), so it tends to wear off faster then a longer lasting insulin like Prozinc or Lantus. so it's totally normal to have it higher in the preshots, then lower mid cycle, then go back higher.

 

Oh wow that makes total sense... I didn't think about that my mind is racing with all the new information and everything going on. So that means that his blood sugar in the morning will typically be higher as the night time dosage has worn off. Similarily, the late afternoon may be higher because the morning dose has worn off.. I understand now. So the 10 pm feeding may have contributed just because the insulin wore off. I wonder if I should be asking for something like the Prozinc or Lantus from my vet. I don't think the huge swings are good for Oscar? I'll see what the monitoring over the next few days brings out.

Thanks Janet!!

 

Well, you certainly can wait and see how he does on the Caninsulin. My cat was on Vetsulin in the beginning which is just a different name for the same insulin. She took about 3 months to get into a better range, but then by month 4 I got her into remission. That being said, some find it hard to regulate on caninsulin because of the shorter duration and find they do better on Prozinc or Lantus, but some, like my cat, do fine on it. I started testing about two months after starting, so you won't see numbers for me in the beginning but if you look at my spreadsheet under the 2016 tab you can see how it went for me. So after a year in remission my cat unfortunately came out of remission... and we again tried vetsulin since she did well on it in the beginning, but it didn't work this time around. We later found out it was because my cat developed a tumor in her pituitary gland which is what was causing the high numbers. I switched to Prozinc because the Vetsulin was stinging at high doses, and Prozinc does not. So she has now been on Prozinc for the past three years. More cats do better on the longer acting insulins, but some do fine on caninsulin. You could always try it for a couple months and decide if it's working for you or not.

 

For pancreatitis Max needed ondansetron or cerenia for nausea, sometimes cyproheptadine as an appetite stimulant, buprenorphine for pain and rarely sub-q fluids if not eating enough or if he vomited which rarely happened. A few times a brief course of flagyl was need for diarrhea. Have you given any of these treatments? What symptoms have you seen?

 

Hi Carolyn just to be sure you are aware , after Oscar eats you wait 30 minutes to give Vetsulin. You couldn't have found a better group of members .
I wish you and Oscar all the best.

 

Thankyou... I will try it for a bit first - see if I can get Oscar's numbers stabalized - then go from there I'm creating graphs and will transfer my data to the spreadsheets soon.

 

Thankyou for your reply!! I do have cerenia 'in case' he needs it according to the vet but I haven't been given any direction to give it to him on a regular basis. I haven't been given cyproheptadine or buprenorphine and no sub-q fluids. I am going to ask about the buprenorphine as it was recommended to me on Friday from a post I put in my IBD group - we were given gabapentin for pain. We haven't been given anything for diarrhea either as he hasn't had any basically since being on prednisolone so we are good there. The symptoms kind of started 3 to 4 weeks ago... greasy coat, a little more lethargy, and oscar seemed to be sitting in positions that signaled he was either in pain or at least uncomfortable - oh how I wish he could just tell me how he was feeling!

 

Hi Diane, thankyou very much for your reply! My vet didn't initially tell me about the 30 minutes we needed to wait - all the articles on this wonderful group helped me figure that out. As a result his first dose was likely a combination of too early as well as too much. On sunday evening for his second dose we waited the 30 minutes and used a 1/2 dose and the results were much more desirable. Today has been pretty good even thought it started out not so good. I'm doing blood glucose every two hours throughout the day and we started at 20, dipped to around ~15.5 and just started creeping back up to 15.9 at about the +8 hours after the insulin shot this morning. Next BG is in about 1.5 hours so I'll know more then.

 

If you need help with setting up the spreadsheet we use just ask we have a member that will gladly set it up for you

 

Hi Janet, I've created a spreadsheet for Oscar as well as a graph (on a separate tab). If you have time to have a quick peek I'd like your feedback. What's interesting to me is that on Day #1 I gave Oscar an evening 1/2 dose of insulin his numbers in the morning were higher and he seemed lethargic and slow in the morning - he also had a rough night. Last night I skipped the evening dose (his BG was 16.1) and his numbers this morning were lower. I did hive the 1/2 dose this morning thinking it would drop his numbers but it has stayed pretty steady so far at +7 hours. Any thoughts or guidance on what you are seeing? Let me know... i super super appreciate it!

 

Hi Diane, I created a spreadsheet for Oscar and would like any feedback you have. I did also create a graph - there is a separate tab for that. Let me know if you see anything surprising or anything that you feel needs to be checked into further. Thanks!!!

 

Hi... Just looked at your spreadsheet. Great job setting it up. I would get a few more days of numbers, but it looks like 0.5 is not enough insulin. If he remains in the mid to high yellows I would suggest raising to .75. Lets give it a few more days though and then decide. You are doing a great job.

 

The unsteadiness you saw a few days ago could have been from the gabapentin. Your cat is really tiny, so even a tiny amount can make them woozy. My cat is 15 lbs. and even half of her prescribed dose makes her unsteady. I gave a little to my 5lb cat before a grooming because she's CRAZY and would try to eat the groomer.... and even giving a little she was falling all over the place for HOURS.

 

Agree.


Mogs
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Hi Carolyn,

Another possible cause of the severe lethargy you observed may have been due to the body's reaction to the Caninsulin itself (though there no guarantee whatsoever that this might be the case - all one can do is speculate based on observations of responses in other cats). Some cats react initially by becoming lethargic while the body gets used to an endogenous insulin but it should wear off after a day or two. Because Caninsulin's action in cats is typically quite harsh, the lethargy may be very pronounced indeed.

Not all insulins agree with all cats. It is worth making brief notes of observations like this in Oscar's spreadsheet remarks because it may help you to spot any pattern responses. In particular, if Oscar is OK at the beginning of the cycle, very lethargic while the insulin is working hardest but then his energy levels start to pick up again in the few hours before the next dose is due, it may be that Caninsulin just doesn't agree with him. We have seen responses like this in other Caninsulin cats, including my own Saoirse. When she was on Caninsulin, between the hours when it was at its strongest and when the dose wore off it was like having two different cats.

Let your vet know what you observe. If the lethargy is persistent then a change to a different insulin may resolve the problem. In Saoirse's case, her switch to Lantus was transformational. I got my cat back. (((Saoirse)))

When Saoirse was first diagnosed, the practice where we were registered at the time was positively hostile to home blood glucose monitoring (and even urine glucose monitoring!). I went through the daily hell of seeing my beloved girl lying there looking completely poleaxed during the hours when the Caninsulin was working at peak effect and not knowing whether it was a reaction to the treatment or whether she might be having a hypo. The only way to tell the difference is to check blood glucose level at the time. Shortly after Saoirse's Dx, we moved to a different veterinary practice with a much more progressive, up-to-date approach to management of feline diabetics and our new vet taught me the basics of home testing. (Our main vet had a diabetic cat!) I went home after the tutorial and cried my eyes out with sheer relief. It was the first time I had a shred of peace of mind since the day Saoirse had been started on insulin.

It's great that you're already home testing, Carolyn. Any time you're concerned about Oscar's clinical signs or behaviours, just whip out that meter and check he's OK.


Mogs
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Thankyou Janet! I love doing spreadsheets but I'm more familiar with Excel so it was a bit of a learning curve. I'm working on getting all of the labs put in now. I agree I would like to get a few more days at 0.5... Oscar had really bad diarrhea last evening and overnight and with his IBD I'm worried about it. He hasn't had diarrhea that watery for a long time - I'm not sure if insulin can cause this so I'll keep a close eye on him today. His sugar was down a little this morning so that gives me hope... I'm going to sit at 1/2 dose for a few more days and see if the diarrhea resolves. Have you seen this before? Thanks for your words of encouragement - I don't feel real good about things yet but hopefully in another week or two I will feel less stressed. Thanks for taking the time to chat with me and answer my questions!!

 

Thanks Janet... I agree the gabapentin could have contributed... I stopped giving it to him yesterday so I'll see how he is today - yesterday he seemed more steady and perky.

 

Thankyou for your comments!! and thankyou for telling me about your experience with Saoirse - honestly it's these stories that give us the information we all crave - so thanks for sharing! Oscar had really bad diarrhea overnight so if it continues i will let the vet know. They are going to do phone call check-in tomorrow - I'm hoping that the diarrhea is resolved by then but if not I will ask about the insulin being the cause. Crossing my fingers that oscar has a better day in the litter box than he did overnight.

 

I'm sorry to hear about your boy's diarrhoea. (((Oscar)))

Is the diarrhoea quite whiffy at all? If it doesn't resolve promptly, as a precaution I'd suggest asking your vet about a Spec fPL test for pancreatitis, if only to rule it out. (It's not an uncommon condition seen alongside diabetes and/or IBD.)

Fingers and paws crossed that your little fella will feel better soon.


Mogs
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Google Sheets is rather clunky in comparison.


Mogs
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Thankyou Mogs! Oscar's diarrhea was quite liquidy/puddly last night but yesterday and the day before his BM's were quite a large volume and a bit fluffy if you know what I mean? This afternoon he had a BM that was more like soft icecream so the diahrrea seems to be getting better. I'll wait and see what it's like overnight and when the vet calls in the morning I'll check - we did have a sample of blood sent for an fPL and a few other things so hopefully I'll get those results tomorrow as well. Thankyou for your well wishes!!

 

Bit like the texture of really soft marshmallow?


Mogs
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Yes... very much like a soft marshmallow... it was like they had small air bubbles in them - it was light brown/beige coloured. Lol only cat moms talk a lot about poops colours and textures...

 

What you're describing sounds like steatorrhea (fatty stool). One possible cause - particularly if the faeces are pale or clay-coloured - might be an issue with pancreatic enzymes (even more so if the stool is quite 'whiffy'). It's good that your vet is running another Spec fPL test. Hopefully it's just a temporary problem. The shift to soft-serve is a movement in the right direction. (See what I did there? )

Saoirse had a really bad pancreatitis flare not long after she was diagnosed. She had steatorrhea for a few days and ye gods! did her poop stink. We're talking offences against the Clean Air Act here. She then had watery diarrhoea for ages. I got to the stage where I despaired of her ever having a solid poop again. Eventually I got the right treatments in place for the pancreatitis and found a food that agreed with her better. Normal service resumed thereafter. (Our vet follows the TAMU protocol.)

I found this to be an extremely helpful resource:

IDEXX Feline Pancreatitis Treatment Guidelines

It's got pretty much everything you might need to look for from your vet WRT management of the pancreatitis, and from a source as reputable as it gets.

Depending on how things go, it might be worth investigating possible maldigestion/malabsorption issues - e.g. tests for B12/folate levels, exocrine pancreatic insufficiency (fTLI). Indeed, a course of B12 can give a real boost to a pancreatitis kitty.

Further helpful resources:

TAMU - Serum Cobalamin and Folate Levels

TAMU - B12 Supplementation Protocol

TAMU - TLI test

ibdkitties.net - Importance of B12

It's thrill-a-minute stuff, innit!



Mogs
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Hi Mogs, thankyou so very much for all the great links! I finished reading them all and it's a lot of great information. Yesterday I found out from my vet that Oscars TLI was 162.7 ug/L so definitely high : no EPI but shows chronic or acute pancreatitis for sure based on what I read. I'm going to call today and ask about the fluids - I feel like Oscar is a bit dehydrated so the sub q fluids would help I'm sure. I also found out that Oscars B12 was >1000 ng/L which is good - and way better than he was last time he was tested. Last time he was <150!! So that has improved and we'll keep up with the injections.



It's thrill-a-minute stuff, innit!


It sure is a thrill lol - I'm sure my kids are tired of hearing me talk about it haha! Last night was a better night in that department. I loved your funny comments about the clean air act - we've had those same offences here lol!! Oscar only pooped once overnight and it wasn't diarrhea thankfully. Soft serve yes haha... his sugar was up a bit this morning - not sure why. I'm considering changing his diet to raw (frozen): I've seen good comments about Stella and Chewy's Duck Duck Goose - low in carbs (lower than the fancy feast we are feeding). I wonder if that would help? I'm not going to make a change in food just yet but I am looking for recommendations if you have any? Thanks so much!!

 

In the post above, Carolyn wrote:

Glad to hear that Oscar's poops are firming up. Be sure to tell your vet the fatty stool and that his bowel motions have been malodorous (important diagnostic info).

I'm tagging @Wendy&Neko to ask her to give you some pointers on raw diets.


Mogs
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There are lots of options for raw food, from premanufactured (like Stelly and Chewy's, Primal, Small Batch and many others depending where you live), to making your own with a premix, such as FoodFurLife's EZComplete to Alnutrin. I live in Canada where there are more and different options, so not the best source of information on what raw diet options are available where you live. I will say that your nose will appreciate the change. The Duck Duck Goose is likely higher in fats, as both duck and goose are fattier meats, which also means higher calories. Other meats like rabbit and venison are lower fat. IBDKitties is supposed to have a good FB group that can help with raw choices as can this page on raw feeding for IBD cats.

 

@Wendy&Neko - Thanks, Wendy.


Mogs
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