? IBD Making Diabetes difficult to control for our Sir Thomas, Advice Wanted :)

[Charlene0718]

Hi there,

Our original story:
https://www.felinediabetes.com/FDMB/threads/introduction-and-help-pls.244898/#post-2762917

Follow up threads:
https://www.felinediabetes.com/FDMB/threads/3-23-sir-thomas-amps-7-8.245127/#post-2766481

In a nutshell, Sir Thom hasn't been eating well for months and after 2 visits to the ER, one for hypoglycaemia and one for DKA which then resulted in a transfer to see an internal medicine specialist for another couple days...it is suspected from ultrasound and liver aspirid, and lab work that my cat has IBD alongside diabetes. Previously treated for pancreatitis and fatty liver as well. THANK YOU to this group for helping my Sir Thomas. He very well may not be here if I hadn't found this group.

Fast forward, after his second ER visit and transfer...He left the internist ER clinic on 1.5 units of lantus twice daily, a steroid .5ml Budesanide, and 90 mg Denamarin. His vet approved food is Royal Cannin selected protein (15% carbs wet food) that he refuses to eat, his dry is Royan Cannin AN allergenic that is 40% carbs (he is actually eating an appropriate amount of this high carb food and its the first time in months he has ate this well! about 3/4 cup a day) and I know it is terrible for his diabetes but the vet said that the IBD treatment has to come first because if he won't eat, we can't properly control his diabetes or anything else and he will just end up back in ER..

As you can see in my chart, he still had extremely high numbers, so we went to 2 units without the vets advice because I could not get a hold of the vet and my next appointment is not until May 19th and I am nervous about him going into DKA again. It seemed like he bounced a bit today

He will eventually need an invasive surgery to confirm his IBD but he was not doing well getting himself out of sedation so we have not done that yet. He also had previous unknown allergies (balding tail) that was treated on atopica but he has been off for 2 months and we will need to do allergy testing down the road but that is going to take time.

Does anyone here have recommendations on insulin dose? Questions or thoughts I can bring to the internist on May 19th? Diabetic friendly food that is okay for allergies and IBD? He was not doing well on fancy feast or friskies and the vet has instructed to stay on the royan cannin but it is killing me to see his numbers so high.

Any advice is appreciated!

 

[Charlene0718]

@Bron and Sheba (GA) I am not sure if you remember my story but you helped so much before. I am open to all continuing suggestions!

 

[Bron and Sheba (GA)]

Charlene I do remember you but let me look back to familiarise myself with it all. . Not sure if I will be straight back ... but I will be back

 

[Charlene0718]

Charlene I do remember you but let me look back to familiarise myself with it all. . Not sure if I will be straight back ... but I will be back

No rush at all and thank you so much!!

 

[Bron and Sheba (GA)]

I am so sorry to hear Sir Thomas has been so unwell and had DKA!
Please keep posting so we can help you get through this.
After DKA it is really important he eats well and gets enough insulin. They are the two things that you can do to make sure ketones don’t reappear. Also making sure he has plenty of fluids is important and any infection treated promptly.
Are you testing every day for ketones in the urine? This is important you do this. This will give you a heads up that he is getting enough insulin and food.

After DKA it is also really important that you ensure Sir Thomas is eating 1 1/2 times as many calories as he normally would. This is because food helps stop ketones forming. So, as much as I dislike high carb dry food, I agree with your vet that eating ANY food is the most important thing at the moment.
Is he still having antinausea medication?

As long as you can test frequently, I would increase the dose to 2.25 units twice a day.
Because you are feeding a dry food you can only do the SLGS method .. have a look at the dosing methods at the top of the Lantus page.
If you are happy with that, can you put SLGS into yourSS and the signature please? That helps us help you.
I have increased his dose sooner than normal when on SLGS but that is because of the DKA. But please make sure you test frequently.

 

[Charlene0718]

I am so sorry to hear Sir Thomas has been so unwell and had DKA!
Please keep posting so we can help you get through this.
After DKA it is really important he eats well and gets enough insulin. They are the two things that you can do to make sure ketones don’t reappear. Also making sure he has plenty of fluids is important and any infection treated promptly.
Are you testing every day for ketones in the urine? This is important you do this. This will give you a heads up that he is getting enough insulin and food.

After DKA it is also really important that you ensure Sir Thomas is eating 1 1/2 times as many calories as he normally would. This is because food helps stop ketones forming. So, as much as I dislike high carb dry food, I agree with your vet that eating ANY food is the most important thing at the moment.
Is he still having antinausea medication?

As long as you can test frequently, I would increase the dose to 2.25 units twice a day.
Because you are feeding a dry food you can only do the SLGS method .. have a look at the dosing methods at the top of the Lantus page.
If you are happy with that, can you put SLGS into yourSS and the signature please? That helps us help you.
I have increased his dose sooner than normal when on SLGS but that is because of the DKA. But please make sure you test frequently.

Thank you!! The syringe we have only has .5 units, can i buy ones with .25??? I am having troubles testing him right now, having to poke 3 or 4 times to get enough blood i will keep doing it though.

He is actually eating his dry kibble really well, i hope it keeps up! I think he should be having more water though, so i keep trying to water down the wet in attempts to tempt him.

I have been testing for keytones, negative so far, fingers crossed. It has been so stressful so i appreciate the support!

 

[Charlene0718]

I am so sorry to hear Sir Thomas has been so unwell and had DKA!
Please keep posting so we can help you get through this.
After DKA it is really important he eats well and gets enough insulin. They are the two things that you can do to make sure ketones don’t reappear. Also making sure he has plenty of fluids is important and any infection treated promptly.
Are you testing every day for ketones in the urine? This is important you do this. This will give you a heads up that he is getting enough insulin and food.

After DKA it is also really important that you ensure Sir Thomas is eating 1 1/2 times as many calories as he normally would. This is because food helps stop ketones forming. So, as much as I dislike high carb dry food, I agree with your vet that eating ANY food is the most important thing at the moment.
Is he still having antinausea medication?

As long as you can test frequently, I would increase the dose to 2.25 units twice a day.
Because you are feeding a dry food you can only do the SLGS method .. have a look at the dosing methods at the top of the Lantus page.
If you are happy with that, can you put SLGS into yourSS and the signature please? That helps us help you.
I have increased his dose sooner than normal when on SLGS but that is because of the DKA. But please make sure you test frequently.

He had cerenia before but he has since finished it. He is interested in food, mainly human food and keeps stealing my son's bread from him if i turn my head. He will eat friskies food but im concerned ill send him into another flare of IBD too if i give that to him

 

[Bron and Sheba (GA)]

Thank you!! The syringe we have only has .5 units, can i buy ones with .25??? I am having troubles testing him right now, having to poke 3 or 4 times to get enough blood i will keep doing it though.

He is actually eating his dry kibble really well, i hope it keeps up! I think he should be having more water though, so i keep trying to water down the wet in attempts to tempt him.

I have been testing for keytones, negative so far, fingers crossed. It has been so stressful so i appreciate the support!

Well done testing for ketones. Keep it up, it’s very important!
You use the 1/2 unit syringes you have already. You have to eyeball the amount which is half way between the 0 amount and the 0.5 unit amount.

 

[Bron and Sheba (GA)]

He had cerenia before but he has since finished it. He is interested in food, mainly human food and keeps stealing my son's bread from him if i turn my head. He will eat friskies food but im concerned ill send him into another flare of IBD too if i give that to him

Have you thought about a home made raw diet?
That is usually really good for IBD kitties.
You can get supplements to add to the raw meat to make it complete nutritionally. If you are interested I will tell you more.

Just a caution.....when you are feeding a high carb dry food like you are at the moment, you are having to give more insulin......
If you are also giving low carb food ( which is fine) you need to be aware that the BGs could drop.
So I would only give the low carb wet food when you are around to test the BGs to see he is not dropping low. Or you could feed some wet then some dry so he is getting a combination ....that would keep the BG a bit higher.

With testing the BGs.....are you warming the ear first? And ‘Milking the ear to bring blood into the area?
what size lancets are you using? Size 26 and 28 gauge is best as they are bigger and you are more likely to get blood.
The other option is to give two jabs close to each other and use both spots to get the blood from.

 

[Butters & Lyla]

I'm so sorry to hear that Sir Thomas has suspected IBD. There are also a couple of websites that are a wealth of knowledge on IBD, including one entirely devoted to raw feeding. You may want to poke around them if you have time.
https://www.ibdkitties.net/
https://www.rawfeedingforibdcats.org/

As you poke the ears more, more capillaries will grow and it becomes easier to get blood out of them as time goes on. I found it challenging with butters for the first three months or so, then her ears started to bleed very easily.
Bron mentioned warming the ear. Some people put rice in a baby sock, warm that up and hold it against the ear. Warming helps an awful lot.

 

[Charlene0718]

Have you thought about a home made raw diet?
That is usually really good for IBD kitties.
You can get supplements to add to the raw meat to make it complete nutritionally. If you are interested I will tell you more.

Just a caution.....when you are feeding a high carb dry food like you are at the moment, you are having to give more insulin......
If you are also giving low carb food ( which is fine) you need to be aware that the BGs could drop.
So I would only give the low carb wet food when you are around to test the BGs to see he is not dropping low. Or you could feed some wet then some dry so he is getting a combination ....that would keep the BG a bit higher.

With testing the BGs.....are you warming the ear first? And ‘Milking the ear to bring blood into the area?
what size lancets are you using? Size 26 and 28 gauge is best as they are bigger and you are more likely to get blood.
The other option is to give two jabs close to each other and use both spots to get the blood from.

I'm so sorry to hear that Sir Thomas has suspected IBD. There are also a couple of websites that are a wealth of knowledge on IBD, including one entirely devoted to raw feeding. You may want to poke around them if you have time.
https://www.ibdkitties.net/
https://www.rawfeedingforibdcats.org/

As you poke the ears more, more capillaries will grow and it becomes easier to get blood out of them as time goes on. I found it challenging with butters for the first three months or so, then her ears started to bleed very easily.
Bron mentioned warming the ear. Some people put rice in a baby sock, warm that up and hold it against the ear. Warming helps an awful lot.

Thank you both! We have been trying the warm sock trick and it helps but still needing a lot of pokes so i am looking forward to it getting easier over time! He used to bleed so easily so I am not sure what changed. I can't find the lancet size on the box so i will google to see if i can figure it out- thank you so much!

We are taking your advice and going up to 2.25 tomorrow and (asking forgiveness to the vet later ). we couldn't do it earlier because we were gone in the day to monitor but im home all day tomorrow.

Thanks so much for the ibd resources, we will check that out this week!

Great point about the wet food, he wont touch it for now but if he does start i will monitor that closely. This has been so helpful, i hope i can figure out his food so i can treat the ibd and diabetes rather than jt working against each other.

Many many thanks!

 

[Bron and Sheba (GA)]

Please stay in touch and keep posting. It takes time to get over DKA and there can be little setbacks which we can help you with.
Main things to remember which are really important:

• Needs to eat lots of food during the day and evening.
• Needs lots of fluids.
• Don’t skip insulin doses
• Test daily for ketones
• Treat any infections immediately.
• Keep asking questions

As you are using Lantus, I think it would be a good idea if you started to post over on the Lantus page where there are lots of people who can help you. I’ll give you the link. When you post you put the date, name of kitty and the AMPS and then whatever you need to ask.
So I would put 5/15 SirThomas AMPSxxx post DKA. That will get the eyes on it or you.
I will watch out for you.
link to Lantus forum
https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

 

[Sienne and Gabby (GA)]

One of the major issues with treating IBD is to feed your cat novel proteins. It looks like the Royal Canin that you're using is not an animal protein based food. Aside from the carbs, I have no clue what this means for Sir Thomas'n level of nutrition. The Raw Feeding for IBD Cats has both a website and a Facebook page. They are great about answering questions on the Facebook page.

I have a non-diabetic with IBD. Gizmo was fed a diet of chicken and turkey for years. He's to completely. off all poultry. Beef and fish are also foods that many cats develop sensitivities too. He now eats raw pork combined with a premix that supplies the necessary nutrients, ZiwiPeak venison, and freeze dried raw rabbit. He also get a small amount of prednisolone. I'd also be careful to choose food options that don't include gums or carrageenan.

 

[Charlene0718]

One of the major issues with treating IBD is to feed your cat novel proteins. It looks like the Royal Canin that you're using is not an animal protein based food. Aside from the carbs, I have no clue what this means for Sir Thomas'n level of nutrition. The Raw Feeding for IBD Cats has both a website and a Facebook page. They are great about answering questions on the Facebook page.

I have a non-diabetic with IBD. Gizmo was fed a diet of chicken and turkey for years. He's to completely. off all poultry. Beef and fish are also foods that many cats develop sensitivities too. He now eats raw pork combined with a premix that supplies the necessary nutrients, ZiwiPeak venison, and freeze dried raw rabbit. He also get a small amount of prednisolone. I'd also be careful to choose food options that don't include gums or carrageenan.

Thank you so much. I have had so much trouble with him eating, I am hesitant to switch him off the royan cannin kibble even though it is so high in carbs because he just went down hill so so fast when he stops eating. Even with the kibble, it is the only thing I can get him to reliably eat, and I even need to feed him out of my hand to make sure he eats enough throughout the day. It really is time consuming and only possible due to working from home with covid right now. I am apart of the IBD facebook group and am learning so much so thank you so much for that . I was really hoping to find a boughten food if I can because with working more than full time from home with no childcare for a 1 year old and all the BG testing and following him around to be his personal food dish, I am having difficulties getting enough sleep so would like something sustainable for me until covid is better in my area and I can get help for childcare etc. Thank you so much for the caution about gums and carrageenan, I still have so much to learn about both IBD and Diabetes!

Please stay in touch and keep posting. It takes time to get over DKA and there can be little setbacks which we can help you with.
Main things to remember which are really important:

• Needs to eat lots of food during the day and evening.
• Needs lots of fluids.
• Don’t skip insulin doses
• Test daily for ketones
• Treat any infections immediately.
• Keep asking questions

As you are using Lantus, I think it would be a good idea if you started to post over on the Lantus page where there are lots of people who can help you. I’ll give you the link. When you post you put the date, name of kitty and the AMPS and then whatever you need to ask.
So I would put 5/15 SirThomas AMPSxxx post DKA. That will get the eyes on it or you.
I will watch out for you.
link to Lantus forum
https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Thank you so much, I have continued with the recommendations so far and tomorrow is his internal medicine specialist appointment so I will post again as soon as I have a chance with the additional info I get from that appointment. Many thanks!

 

[Bron and Sheba (GA)]

Good luck with the specialist apt. Please let us know how you get on.