IBD and diabetes

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Sgans and Eegie - GA

Sgans and Eegie - GA

Member Since 2015
Hi guys. Who here has cats with these 2 problems together? I finally figured out that Eegie's appetite is good when he's in the 200's, usually pre-shot (he's only been on insulin about 5 days), and lousy when he's down in the Blue, while the insulin cycle's working.

The IBD makes the appetite issue even harder, as he's so particular about what he eats, and I have so few choices to feed him.

Also, I thought he'd had constipation from the insulin (few, small poops or none at all), so I stopped some of what I give him for his usual diarrhea. And, I gave him SEB and a little petromalt. Well, I was wrong - what a mess tonight!

So, he'll be back on S. Boulardii in large doses for 2 days - and the rest of his regular intestinal regimen to get him back in shape.

I'd like to know how IBD parents are dealing with diabetes... any new tricks. Eegie's had IBD for over a year, so I do know all the old tricks at this point - but the insulin thing puts a twist on stuff!
 
It sure sounds like you have your hands full! Of my six cats, one is diabetic, one suffers from hypothyroidism, one has a heart murmur, asthma and nasal polyps, and one is just an ill-tempered witch. I also have a 15 year old Pekingese dog, that I just adopted last September, with severe congestive heart failure and only about 20% kidney function. But, thank God, the diabetic has only that one issue. My vet is remodeling his clinic (much needed) and I can't help but think I'm paying for the lions share! He's a really good vet tho!
 
I'll bet you at least own the reception area!

I keep saying that if my vet had kids, their college fund would be set! (Say that about my dentists, too)

My other babies have occasional issues, but nothing chronic (one cat may need a lump removed), but poor Eegie is taking on the brunt of everything for everyone, it seems.

Just like him, he's such a giver, he'd probably have offered if he could speak. I love that boy!

I have no idea how you manage to find time to go to the bathroom, with all you have in your home! Thank you, for caring for so many difficult ones.
 
Sgans said:
I'll bet you at least own the reception area!

I keep saying that if my vet had kids, their college fund would be set! (Say that about my dentists, too)

My other babies have occasional issues, but nothing chronic (one cat may need a lump removed), but poor Eegie is taking on the brunt of everything for everyone, it seems.

Just like him, he's such a giver, he'd probably have offered if he could speak. I love that boy!

I have no idea how you manage to find time to go to the bathroom, with all you have in your home! Thank you, for caring for so many difficult ones.
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I hear that a lot from people! Lol. It can be interesting sometimes, especially at feeding time! The old song "You Can't Rollerskate In A Buffalo Herd " comes to mind during what I call the "feeding frenzy". Yikes!
 
Mine was diagnosed with small cell lymphoma of the bowel about 16 months ago. But both B-cell and T-cell clonality tests were negative, which to me means it can't be lymphoma (vet pathologist disagreed with me). Regardless, he underwent 8 monthly cycles of lomustine chemo (no medrol since he was diabetic in remission) and didn't do well, continuing to lose weight. I was desperate and about to euthanize him, but requested any last ideas from the cat specialist in San Antonio (Dr. Norsworthy... writes the cat texts for other vets). He suggested a tiny dose of flagyl, which I gave him and he promptly turned around and started gaining weight for the first time. Repeat exp. lap showed very mild inflammation (possibly within normal limits), moderate fibrosis and no evidence of cancer. That was Sept last year.

As you may be aware, there is an overlap category between severe IBD and lymphoma where diagnosis may be difficult. Many vets feel IBD can progress to lymphoma. That's what my cat had (in addition to his diabetes, formerly in remission, but now he's out, a rodent ulcer on his lip where a course of depo medrol led to a dx of pancreatitis and diabetes, followed by a difficult month with anorexia, a feeding tube, TR with prozinc, serial blood glucoses, a vet repeatedly encouraging me to euthanize, etc., etc.). So, yes, in broad brush strokes, I've followed the path of a kitty with severe IBD and diabetes. Any specific questions?
 
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Thanks, @Sandman Just requesting new ideas. I've been on the IBD path for well over a year, and now with diabetes going into my 3rd week. He had to have a depo shot last Tuesday and hasn't pooped much since, so I'm working that. Was doing Slippery Elm and then added fish oil. No go for a coupla days so today did docusate +fish oil in morning meds. He's been on flagyl for many months, in support of budesonide. I'm so glad the flagyl worked for you!
It certainly sounds like you've got your baby under control. I'm pretty sure we're not putting him through chemo - he doesn't have lymphoma - he has primary lung cancer - and at his age ,the prognosis even with treatment isn't much of an improvement over non-treatment (I have a great oncologist - and she's got ideas, but we need to get at least his BG under control first - which was happening prior to the depo shot).

So - seeking ideas in all areas - ones that are "out of the box" (not the litter box, we're already out of there), 'cause we've been doing standard and non-standard things - regular meds and herbal (and some homeopathic), and I'm just wondering if anybody else has found great ways to get them to eat, that I haven't tried, great ways to get them their poop solid (or today, get it GOING), that I haven't tried. The IBD is something I'm used to, the diabetes/insulin reactions, not so much. For example, he's never gone this long without a poop.

Yesterday early, there was one, very small, creamy poop (had been liquid prior to the depo, had been perfect up until insulin), and with his remaining neuropathy (GREATLY improved since a week and a half ago) he spread it around the house... he pees on puppy pads... most of the time...

Just... seeking input. Thanks!
 
Not sure I have much to add. I have foresworn use of steroids in my cat, though the cat specialist keeps trying to push me to give them another shot. Yes, I realize they are the mainstay of IBD therapy. However My Sluggo swung wildly out of control (temporarily) while in diabetes remission with them. Budesonide SHOULD HAVE theoretically been better, but he'd be ok for about 3 days on that before his blood sugars would start lifting off. Flagyl saved his life and a tiny dose (62.5 mg once per day) keeps him symptom free. The cat specialist insists I take him off it one week a month because there is some work showing mutagenic potential IN DOGS. I try to comply, but when his symptoms return with him having it coming out of both ends, I retreat. Probiotics are theoretically a good idea, but when I'd put fortiflora on his food, he would turn up his nose at the food and afterwards when I subsequently put out the food without, he'd turn up his nose at that. You really have to count your blessings. Diabetes remission is a big one I never appreciated until an oral infection knocked him back out. Finding a canned food he will actually agree to eat is another. I did find however, he would eat canned food with the fortiflora blended in as a result of trying to feed him during his dental issues. I gather blending the fortiflora with the food may kill/weaken the bacteria, but figure some probiotic is better than none. I had used his weight as an index of health, since weight loss was the most prominent initial symptom of his IBD/lymphoma and what tipped me off something wasn't right; I took to weighing my cats after missing a 1.5# weight loss in his buddy, Mr. Bill (GA) who succumbed rapidly to large cell lymphoma of the liver --- I had to euthanize and am still in pain over that one 18 months later :( . What I have to deal with now is slimming him down since he's gotten so heavy while still gauging control of his IBD/lymhoma. He could afford to lose a pound or two and it would make his diabetes issues easier to manage. The new and improved (local) vet I recently found exclaimed, "he does NOT have lymphoma!", taking one look at him 16 months after diagnosis. He's a big boy. He's a sluggo.

About the only thing you didn't mention was cyclosporine. I have resisted going that route, but it is an immunosuppressive that won't wreak havoc with the diabetes. If flagyl ever fails to control sluggo, I may go that route, but have resisted because it's pretty heavy duty. If he doesn't have cancer now, he may after being on that one for a while. Any thoughts?

Appetite stimulants are sometimes useful as well. They are most useful before the cat becomes completely anorexic, but I will use mirtazapine. You can give 3.75 mg (1/4 pill) every other day chronically and even every day acutely (per Dr. Norsworthy). It also is a potent anti-emetic. He does get very vocal when I give it, purs much more and gets aggressive with the other kitties. An idea. Cyproheptadine has also been used in that regard. Furthermore, I think it can be used to treat an adverse side-effect of the mirtazapine (serotonin crisis??). But I've never given that.

You didn't mention B12 supplementation, but Dr. N recommended that and he's been on it since his dx. I keep asking the local vet (the smart one) when I might stop giving that, but I guess the answer is NEVER. Aside from being one more shot I have to give him as a water soluble vitamin, it probably does no harm. Presumption is IBD/lymphoma kitties can't absorb this from their scarred up intestines.
 
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Y'know... we haven't yet used cyclosporin. In fact, I just started learning about it for IBD, after all this time! As with all the anecdotal pages and sites, I read excellent to terrible reviews of it. I WISH we could access what doctors can - and read the actual scientific data. I might not understand it all, but sometimes reading the pages and stories by "regular people" is kind of like reading political advertising. You just never seem to know what the actual truth is! :)

I'm not a fan of the steroids - but somehow, with the insulin his diarrhea got SO bad, we were starting from such a low point that even the localized budesonide couldn't get control. That's the only reason we did the depo shot last week. I was desperate - he'd gone SO many days with just water coming out, and he felt SO lousy! I knew the depo would mess with his BG, but I had to take the chance - so I could get his system to a point when the other meds would work. At the time, he was also regurgitating and vomiting on defecating - that was a new thing. We've used Fortiflora since very early on. Now, he won't eat it at all - I add it to the syringe with his metronidazole at night (and whatever else I can do - he gets so many meds and supplements, I try to combine them whenever possible. I want to try a different probiotic, but haven't found a stable enough state to change him up. You are SO lucky the metronidazole works for Sluggo alone!

I'm so SO sorry to read about Mr. Bill... that pain never goes away. All you can ever do is know you did your very best, and did it out of love. Sometimes, fast is a blessing.... but not for those of us who remain.

My previous cats had never had all that Eegie's going through. One succumbed very quickly to undiagnosed CKD (we called it CRF at the time), another had it long term, another had it short term, but was weakened from a previous surgery and never came back. Even my childhood dog lost it to kidneys. The previous 3 cats never got the chance to become as old as Eegie has, so I don't know what would have come for them, eventually.

For appetite stim, he doesn't seem to react to cyproheptadine, and has used mirtazapine in the past with some success. But he had a UTI not too long ago, and we gave him Amitryptaline for inappropriate urination. It worked for that, for a while, but an unexpected side effect was a real interest in food on his down days! We have him on a small dose of that every evening, and it seems to help - and it also helps relieve some of the stress (so I gather) from all he's going through.

He does get lots of B12. His sub-q (nightly) has B-complex, with B12 cyanocobalamin - but up until 4/26 or so, the doc was blaming his "funny walking" on his cystitis (which was gone). It was on that date, that I learned about METHYLcobalamin B12. We started it on 4/30, at which time he'd been able to go about 5 feet walking on his hocks. Within about 4 days, he was back up on his toes, and although he can't walk too far yet (his belly is distended, he's overweight now, and he's apparently quite constipated), the improvement has been remarkable. The B12 prior to that was making him feel better overall, and improving his appetite and well-being. We keep doing the sub-q because he also gets Lasix every morning - just a bit. His lung tumor had caused a pleural effusion at one point, so this is keeping that in check.

I'm working out another new spreadsheet of his current treatments...

Eegie is now about 2lbs overweight - which I still prefer to when he was about 5lbs underweight at the start of the IBD treatments. We thought we were going to lose him that day - over a year ago - so I'm grateful for all the meds and even the pred, which put him on this diabetes board, but has kept him with me, with a good life quality for all this time. I'm hoping to stretch it further.

I really appreciate your input and ideas - looks like we've been down similar roads. Please hug Mr. Sluggo for me.... he deserves it - as, apparently do you! Thank you!
 
Thank you, @BJM . You'd posted this elsewhere yesterday. It's a GREAT article, and I wish I'd seen it ages ago, when I was still learning the whole system - it's really well done. But - I'm pretty much doing as it suggests.... and am concerned because I'm not getting results, and it's starting to be a longer time than I'm comfortable with. Eegie's a cat who's IBD has always been about diarrhea - these are a LOT of days with no poop or tiny poop. TOTALLY unlike anything he's ever undergone. I Love the article though - actually posted it on another website I'm on that's about IBD...
 
I KNOW! That's what has me worried - with Eegie, that's a death sentence, so I'm doing all else I can. His body will not withstand the treatments for megacolon (there's no obstruction from externals sources, of that, I'm certain - any obstruction would be buildup). If he needs anesthesia, he's going to have big problems. He's got too much going on. Trying as conservative as I can, and getting more aggressive as I can - but invasive treatment will put him in great risk, and I'd like to not get that far...

My vet is in, in a few days - at which point we'll have to see what Eegie's gotten to...
 
FINALLY GOT POOP!!! Small-ish amount, not quite formed, but getting there. As @Sandman knows, we in IBD become all about texture - we get our own language for describing variations, am I right? Well... this, I describe as finely ground oatmeal with just a bit too much water.... (for some reason, food analogies seem to always work for me). :D It's MUCH better texture than pre-prednisolone, but not as good as pre-insulin (which was perfect for a few weeks).
Now I know I can give the fiber, without worry - it's a gentle fiber. I'm going to keep the docusate tonight and the SEB and fish oil - but tomorrow, I'll just do SEB for a while, along with the other meds.

Hoping maybe this is just his new timing, and we can just build up the texture.
Whew!!!
Thanks for letting me vent!
 
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