Kali AmPs 430, +3 220, PmPs 496. Pancreatitis and UTI

[Duggles]

Kali has been OTJ for the last two years on a low carb diet with good BG numbers, but she developed a UTI that seems to have triggered her BG to spike, along with pancreatitis, probably all interrelated.
We took her in to the emergency vet on Sunday morning after she became suddenly very sick on Saturday night. The vet gave her antibiotics for the UTI, sub-cue fluids and she did a full blood panel.
We got her back on Lantus but her BG was still consistently high and then on Monday night I smelled her breath and detected a hint of acetone so we rushed her back in first thing Tuesday morning. They gave her IV fluids and hourly IM regular insulin with a dexrose drip and got her down to the 130-230 range over 24 hours, except for one spike at 510 at 2am, so the vet had to stay with her until 5am getting her BG back down. We caught the ketosis very early and she's no longer ketotic. She came back home yesterday and she's been eating a little bit here and there but we are struggling to keep her BG in check with 2 units of Lantus 2x a day. She will only eat the dry kibble the vet sent her home with, it's a special food for diabetic cats but it's also 18% carbs. The vet says they're complex carbs and it's ok but the third ingredient is corn gluten so i don't fully trust it.
She'll probably go back to the vet for an IM injection of regular insulin to help get the curve down a bit lower and more sub-cue fluids tomorrow.
Any advice on how to manage a cat that is consistently high BG and wont eat very much, along with a UTI and pancreatitis would be welcome

 

[Bandit's Mom]

Hi, sorry to hear she's been unwell and it's good you caught the DKA so early.

Almost all prescription food (wet and dry) is too high in carbs - only the Purina Pro Plan DM canned is low carb at 6%. Prescription kibble must be 25-30% carbs. For now, with DKA/ketones in the picture, it's important that she eats, so if the prescription kibble is all she will eat, let her eat it. Once she is better, you can try to slowly switch her to low carb kibble (Young Again, Dr. Elsey's Cleanprotein chicken flavour and Wysong Epigen), if not low carb canned.

Which antibiotic is she on for the UTI? That can also cause appetite issues. You might want to give her a probiotic like S. Boulardii to help with any GI issues due to the a/b.
Is she in pain due to the pancreatitis? That can elevate numbers as well. Did the vet give you any meds for nausea?
A Primer On Pancreatitis

The Lantus depot takes a week to build. Fast acting insulin will not help beyond a cycle or two. You want to get her to a good dose of Lantus. Since you are feeding dry, you would have to follow SLGS. Can you get some mid-cycle tests to see how low she is going on the 2u dose?
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)


Addressing the UTI and pancreatitis will also help numbers. You also want to keep ketostix at home and check her urine for ketones every day.

 

[tiffmaxee]

Sorry she hit hit with all three things at once. Do you have medication for nausea? Ondansetron works well. You would need an RX from your vet as it is a human drug. Your vet will have cerenia which might work. We’re you given fluids for home?