inconsistent bg levels + regular pancreatitis?

[Puck + Frodo]

Hi everyone! wondering if I can get a second set of eyes on Frodo's glucose chart and just some general advice.

For background: Frodo is about 12 years old and was diagnosed a little over a year ago, and we've been using ProZinc the entire time. it's been tough to land on a dose as it feels like his values range quite a lot from day to day as you can see in his chart. he eats Fancy Feast Flaked Fish and Shrimp Feast (2 cans/day across four meals) and Royal Canin's Glycobalance kibble (around 1/8 cup overnight on an autofeeder).

He had a hairball around 4-5am this morning, and since then has not been able to keep any food down -- he typically eats at 630am and 1230pm, and threw up both of those meals as well as a small snack around 9am. his blood sugar rose during this period. the only big change recently was that we did his shot a bit later than usual last night (830pm vs 7pm). We ran him to the vet right away, and he tested negative for ketones, but the vet is concerned about it developing into pancreatitis or dka within the next day. In general, he's been more lethargic this week and has seemed to be more irritable with our other cats than usual. Until today was eating and drinking normally and haven't noticed any accidents outside of the litterbox. it's also been super hot (over 100F) this week -- not sure if this would have any effect but figured I should note it.

My concern is that I feel like Frodo has had pancreatitis fairly often -- not counting today, he's been diagnosed 3 times over the past year (though thankfully has not had dka yet). Is there anything that I can do to prevent him going through this every few months, or is it just something we have to be prepared for with his diagnosis?

 

[Suzanne & Darcy]

Hello there! It’s nice to hear from you. I’m so sorry that Frodo has been sick. I am concerned about all the vomiting, and I am glad you took him to the vet to check for ketones. It would be better if you had test strips to test him at home for ketones because one day he may be negative for ketones and the next day he could have significant ketones. Since pancreatitis is an inflammatory condition it could put him at risk for DKA.

I am afraid that diabetic cats are prone to bouts of pancreatitis and some cats have chronic pancreatitis with flare ups periodically. Subcutaneous fluids and pain control as needed and appetite stimulants like Mirataz/mirtazapine (as well as anti-nausea meds) and anti-emetics to control vomiting (Cerenia/maropitant) given daily at home are standard care for managing feline pancreatitis.

As for his dose, there isn’t enough data on his spreadsheet to know if his dose is too high or too low. There are only preshot numbers that I can see (am I missing something?) It would be dangerous for me to comment on the regular dose without nadir data. I do see skipped shots when he has a blue preshot number and I think that is a mistake because it is definitely allowing his BG to climb too high. I would start with shooting a half dose of 1 unit when he has a blue preshot, and I would test his BG during the cycle once or twice to see how he did on the half dose. If he stays too high, I would try a little more insulin the next time (1.25 units) and test again to see how the cycle went.