Lots of trouble regulating!

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Maci

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Hi. I run a rescue shelter for cats in CT. A few months ago we took in a local 12 yr old male cat named Maci. For months prior to coming to us the cat had loose stools and would go everywhere. We had him ultra sounded and found he has severe IBD. Then we were all surprised when the bloodwork showed he also had diabetes. Vet wanted him on Pred to help the IBD inflammation and we started the Lantus. Nothing was making a dent in bg or diarrhea so we decided to place him on a. Raw diet. Potok him off Pred at this point also. Amazingly within days his stool formed! Then after a week he had a bad day of diarrhea, vomiting, not interested in food and generally lethargic. Spent night at vet on IV fluids and was placed on Orbax as white count was high.
Came home (I'm fostering, he's not in the shelter) and he seemed fine again. However, stools never formed again and though on 5 units of Lantus twice daily his bg is still in the mid 400's. No vomiting. Great appetite, in fact super hungry. Vet thinks pancreatic insufficiency but I don't think she has much experience with cats with this, just dogs. His diarrhea is very foul smelling and often jelly like. No blood. I'm wondering if we should just start him on enzymes and if so what have people had success with?
This poor cat has lived a pretty rough life and we want to try and make him more comfortable. Any thoughts would be greatly appreciated. Oh, we also switched him briefly to Humulin, but that was worse, however when I gave him the Lantus again after the brief Humulin stint his bg went down to 350. Hasn't been there since and now I just slowly increase the Lantus.
I have anther rescue diabetic 8 yr old female who is doing well and one young one who seemed to outgrow hers after a year. But they didn't have the other issues that Maci does.
 
Has the vet prescribed a round of metronidazole? Sometimes, that can help.

Foul smelling, voluminous, grayish or pasty colored poop are characteristic of exocrine pancreatic insufficiency (EPI). It is worth an empirical test of enzyme supplementation to see if it helps. Discuss with your vet.

Have you tested if probiotics are helpful? Some examples include Forti Flora, or Intelliflora, or a teaspoon or two of plain yogurt with active cultures (if the cat is not sensitive to dairy products).

Are you testing the glucose?
What are you now feeding?
Its great you're using Lantus - what dose did you start? How fast did you increase and how big was each increase? If he is getting too much insulin, that could explain part of the hunger, though I suspect it is the food just running through him.
 
Maci's stool is actually quite brown in color, just very foul smelling. He gets picky about additives in his food (probiotics). We had tried FortiFlora and he refused to eat. He's not a pillable cat as he has a tendency to bite.
Yes, we home test every morning. Actually, this morning he was at 391. Lowest he's been in awhile. Perhaps he's just going to need higher amounts of insulin. Time will tell. We're at five units now.
He is eating Rad Cat raw food.
 
Hello to extra sweet Maci and his caretaker!! (we'd love to have your name too)

With Lantus, it's important to get both Pre-shot tests, as well as tests during each cycle. At LEAST one other test during the AM cycle, somewhere between +5 and +7 (5 hours after morning shot to 7 hours after) to help to see how low that dose is taking him. During the PM cycle, you want to at least get a "before bed" test so you can have a good idea on if you might want to set an alarm for more tests overnight. Most cats do go lower at night.

The least number of tests per day is those 4, but if you can get more, that's even better. Lantus dosing is based on the nadir (the lowest point in the cycle) so without having those mid-cycle tests, there's no way to know if he needs more, or even LESS!

Too much insulin can act the same as too little, and if he's already on 5 units twice/day, he's on a VERY high dose. When we see cats that have started on low doses but worked slowly up to around 5-6 units and they're still showing high numbers, we start talking about getting the cat tested for high dose conditions like Acromegaly, IAA and Cushings.

What dose was Maci started at? How were increases done?

The Rad Cat is a good choice since they're all 0-3% carbs.

We can probably help you to get Maci healthier and happier! There is a LOT of experience with diabetes here as well as the other diseases that tend to come with it, like pancreatitis and neuropathy
 
Thanks Chris and China! I did not know about all the testing except when doing a curve. I tested Maci at 7 hours today and his bg was 362. It had been 426 this morning. He had started at 1 unit about five weeks ago.
I will look in to testing him for whatever we need to if it will help him feel better. He seemed to have the first formed stool today (but also a little diarrhea) since his bad episode. I feel that when I get excited about slight improvement, the next day there is relapse. Very frustrating, but hanging in with the big guy. He is a good size cat but not fat. I don't know if he ever was or not. He is an all black male that apparently lived most of his life as a mouser. Don't know what or if he was fed other than what he caught, except for the past two years he was given garbage cat food.
My name is Katherine, BTW!
 
Hi again Katherine!!

My biggest concern right now is that you may be seriously overdosing Maci! If you just started on Lantus 5 weeks ago, and started with 1 unit, then you've been going up in dose WAY too fast!! We do increases in .25 unit increments.

What may be happening is you're giving that high dose, it's taking him TOO low and his liver is panicking because of that. It's called "bouncing". The blood glucose goes too low (or lower than the body has become accustomed to) and the liver freaks out and releases hormones and sugars to bring it back up fast. When our kitties were "in the wild", this was a survival mechanism for them.

It would be VERY helpful for you to start a spreadsheet for Maci so we can help you determine what to do. If you look into my signature box (below this message) you'll see an example of China's for 2014. It's really important that you keep track of Maci's numbers. Here's How to get a Spreadsheet so you can get that up and working.

As I said earlier, it's VERY important that you get at least 4 tests in a day, but if you can get more, it'll help us to see how Maci is doing even sooner.

AMPS--AM Pre-shot test
A +5 through +7 midcycle test

PMPS--PM Pre-shot test
A "before bed" test. This will also help you to know if you need to set an alarm to get up later to check on him. Most cats go lower at night and we just want to keep him safe.

If you've only been on Lantus for 5 weeks and are already up to 5 units twice/day, I think I'd strongly recommend you go back to 1 unit and start over. You may have skipped over Maci's "best dose", and keeping him at those high doses when he may very well not need them can only cause problems, either by causing a hypoglycemic crisis (which can kill quickly) or by making him become resistant to the insulin.

What kind of glucometer are you using to get your tests? Some are better than others, and some are a lot more affordable than others too.

Good to hear you had a better formed poo! We totally understand those little victories!!

Keep asking questions if you have any, and we look forward to helping you learn the steps of this sugardance! It will only help to make Maci feel better sooner!
 
Having a little bit of information gathered together in your User Control Panel, Profile tab, Edit Signature will help us to help you better. Something like this would be very helpful to us.

Katherine & Maci (male, 12)
DX date xx/xx/2014
Lantus and meter used for home testing
Raw diet (Rad Cat)
IBD, persistent diarrhea and any other complicating medical conditions.
 
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