low appetite, low BG

D & Nacho

D & Nacho

Member
I posted this on the sister FB group, but posting here -- @Suzanne & Darcy, new Nacho thread - new issue(s)

Nacho cat has been struggling with appetite the last several days... he's rejecting foods that were staples and we're having a hard time finding a new one he'll eat more than a few bites of

He's also got diarrhea on and off and has been vomiting every few days. Vet doesn't seem concerned and said he'd prescribe anti-diarrhea medicine, but didn't place an RX or tell me what kind. Nacho was diagnosed with IBD a few years ago (probs what caused the diabetes) but he's been really good being off the prednisolone for about a year. I hear mixed reviews on Fortiflora and am a little confused about Boulardii. I kind of assume that the diarrhea is because of the no-dry food diet? His labs all came back pretty good last week...

His BG numbers have been pretty good for a few weeks (finally!!), albeit the last couple days lower than usual - I assume because he's not eating much. We're riding his insulin by .5 units (in .25 increments) based on nadir and amount of food he's eaten. He's dropped below 50 twice this week however. I think he's one of those hypo asymptomatic cats... no change in energy, attentiveness, movement or anything. I don't understand how the same dosage wasn't working a few weeks ago and now it seems like it's too much!
 
Hi there. I am concerned about the vomiting and diarrhea.
But first let me say that EVERY time he drops below 50 he earns a .25 unit reduction in dose. That is not just a temporary reduction for one cycle but the reduced dose is the new dose going forward. He should have had two full .25 unit reductions.
On Aug. 19 he should have been reduced to 3 units in the p.m. cycle and NOT increased back up to 3.25 the following day. Then yesterday he should have been reduced again to 2.75 units and that is now his new dose. This is very important.
 
I want to get back with you on the other stuff but am super pressed for time right now. So I will be back.
Let me say that Forti Flora isn’t a good probiotic for diarrhea. It has only one strain of probiotic in it and it is not effective for diarrhea. Forti Flora has its use as an appetite stimulant because most cats love the flavor of a little sprinkled on their food. Also, try grinding up Pure Bites chicken treats and sprinkling them on top of his food - as an appetite stimulant.

The thing that has made a difference for my IBD cat is to give a daily dose of Visbiome Vet probiotic. It’s amazing stuff. I can’t recommend it highly enough!
 
Oh, and also, wet food does not cause diarrhea. The cat's kidneys do an excellent job of removing water from the intestines to form the stool. Dry food does cause dehydration in cats so that may make a difference but it’s not the way you want to go about resolving a diarrhea problem. If he’s having diarrhea then - with his history- he’s probably got inflammation in his GI tract and the way to find out is to have an abdominal ultrasound. How was he originally diagnosed as having IBD? Via ultrasound? The GI panel bloodwork? So you have not fed him any new types of food?
 
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thanks for all the advice, @Suzanne & Darcy. We'll drop to 2.75 immediately, although right now he's refusing breakfast, so i'm leaning toward a token dose of 1 unit (stalling to see if anyone on the forum, FB group, or his vet weighs in in the next 30 mins). Husband brought him back up to 3.25 - we hadn't had a chance to discuss the reduction when under 50, but we're on the same page now

Yes, originally diagnosed with IBD via ultrasound. We've been trying new foods for a couple days to see if he was just tired of the "same old" - still all Weruva low carb. I even broke out a fish variety this morning but he just kinda licked at it (and canned tuna). The fact that he's rejecting fish tells me something is definitely up.
 
We gave 1.5 units this morning after seeing him eat a little more. Then we went to the vet and got probiotic (will start that at PMPS) and Miratzapine (gave him some about 1.5 hrs ago). Nacho accepted and kept in some boiled chicken at the same time. Vet wants me to go down to 2.5 units immediately. So, the question is, what do I base the PM insulin dose off of?? What if his nadir is decent (above 50 if we're sticking with TR) but he refuses to eat dinner? Then 2.75 or 2.5 will still be too much insulin without food. This is what's gotten us in trouble - the not eating.
 
I see the notes on your spreadsheet. I am really worried about Nacho. It could be something like pancreatitis which can be managed with fluids, pain meds and Cerenia and Ondansetron. Or perhaps his IBD is flaring and he feels nauseated. If he should have to go back on steroids then a lot of diabetic cats can take Budesonide which is a different kind of steroid that works more locally and doesn’t have the same effects on blood glucose levels. But I am really getting ahead of everything. Just let me know how he is doing. I really care. What kind of bloodwork did the vet do the other day? Was it a CBC and chemistry panel? Do you know if they did the feline pancreatitis test (spec fPL test?) or even the snap pancreatitis test. I am just trying to think of things. I see the ER is a long drive away :( I hope you have a playpen or something he can ride in with a litter box. I bought one for my cat Ginger when we went to the cardiologist because it was 2 hours or so away. Of course, I really am hoping he will not need to go there.

While you were stalling this morning Nacho’s BG went way up. How long a period of time was that? I am glad you only gave a reduced dose since you can’t really count on him eating right now. I will be thinking of you all and looking for updates.
 
D & Nacho said:
We gave 1.5 units this morning after seeing him eat a little more. Then we went to the vet and got probiotic (will start that at PMPS) and Miratzapine (gave him some about 1.5 hrs ago). Nacho accepted and kept in some boiled chicken at the same time. Vet wants me to go down to 2.5 units immediately. So, the question is, what do I base the PM insulin dose off of?? What if his nadir is decent (above 50 if we're sticking with TR) but he refuses to eat dinner? Then 2.75 or 2.5 will still be too much insulin without food. This is what's gotten us in trouble - the not eating.
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I am okay with 2.5 units. How far away from shot time are you now? What’s his BG? If he doesn’t eat a reasonable dinner then yes, I believe we don’t want to risk giving 2.5 units. If he’s low then maybe just give 1 unit. But this is still if he eats. He needs to eat, even if he’s willing to eat small amounts but more than just at dinner time. Do you have anything for nausea? Even Cerenia? They really should have given him a Cerenia injection for nausea and vomiting and given you some Cerenia pills. I am surprised they didn’t give him some sub-q fluids as well. Ondansetron (Zofran) is human medication that is more effective than Cerenia for nausea and they could have written you an Rx to have filled at a local pharmacy. But it would definitely be worth trying the Cerenia first as some cats respond well to it and it can be helpful in case there’s pancreatitis. It is not really recommended to give appetite stimulants like Mirtazapine before addressing potential nausea first. It can cause food aversion if you make a cat feel hungry at the same time they feel nauseated.
 
Ugh. They didn't suggest Cerenia. We've had it for him in the past. He's been nibbling on LCW and ate 2-3 tbsp of boiled chicken.

Re: symptoms - his skin scruff and water intake suggests he's hydrated. He's not lithargic or sluggish. He's walking fine and with energy. He isn't super active, but he hasn't been for awhile... he sleeps a lot. He hasn't vomited since AM+10 yesterday. No excessive litter box usage.

I have his lab results as a PDF. Everything except BG was within range (albeit some high and some low end of ranges)

We're at +7.5 and he shot up to 382. The AM nadir is 118.

I think maybe the Mirtazapine is working quickly since he's been eating? We'll see how much he eats for dinner... but now at this point I'm even more conflicted about dosage.
 
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D & Nacho said:
Ugh. They didn't suggest Cerenia. We've had it for him in the past. He's been nibbling on LCW and ate 2-3 tbsp of boiled chicken.

Re: symptoms - his skin scruff and water intake suggests he's hydrated. He's not lithargic or sluggish. He's walking fine and with energy. He isn't super active, but he hasn't been for awhile... he sleeps a lot. He hasn't vomited since AM+10 yesterday. No excessive litter box usage.

I have his lab results as a PDF. Everything except BG was within range (albeit some high and some low end of ranges)

We're at +7.5 and he shot up to 382. The AM nadir is 118.

I think maybe the Mirtazapine is working quickly since he's been eating? We'll see how much he eats for dinner... but now at this point I'm even more conflicted about dosage.
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Okay. The 382 is probably just from the reduced dose. I am very glad that he’s not lethargic. He’s not drinking a lot of water? Sounds like he’s not so that’s good. Be careful how much Mirtazapine you give (it’s the pill form right? Because the transdermal that is put on the ear is called Mirataz) because it can make cats a bit crazy (restless, very vocal and sometimes even aggressive toward other cats) so start with just the lowest amount and you don’t necessarily have to give as much or as often as prescribed. When I use Mirataz, I start with half a dose. But I will be glad if it helps him.
 
@Suzanne & Darcy it's a 15mg pill and they cut the pills into quarters for us, so a quarter pill a day til he gets his appetite back... which as I mentioned, seems to be working already. He has perked up and is talking more than he has the last few days, but he's part Maine Coon so vocal is super normal for him. He's not picking on Taco.

Water consumption normal.

Would you concur with if he eats a good dinner, 2.5 dose of insulin? If he eats little or rejects, token dose of 1.5 again? We do have the probiotics that we're supposed to start this eve with dinner too.
 
Well if he eats a good dinner and his number is in the pink like the last test then you should be okay with the 2.5 as long as you can test some tonight to make sure he is safe. If he has a similar number to this morning then I would go with the lower dose like this morning, although if he’s eating and you can monitor then you can probably shoot a little more (like 2 perhaps.) So you see how it’s going.. If he’s eating well then give a little more insulin than this morning if he has a similar number. If he’s high and also eating then give the full dose. As long as one of you can get a test before bed and later on in the cycle to monitor it should be okay. If he refuses food lower the dose. I hope Nacho feels hungry on his own really soon.
 
PMPS in the pink (324). He ate more dinner than he has all week, but still not as much as I'd like to see. We landed on a skinny 2 dose in hopes that I can get more than 2-3 hours of sleep for the first time this week.

He was so sweet. He ate a fair amount, then hopped up next to me to wait for insulin. I told him to go eat more, he did! Then came back, same thing - go eat more sweetie! The third time he came back after eating he took his insulin incredibly patiently. He actually got the zoomies for about 90 seconds and chased the laser!!! Now he's back for cuddles. Fingers crossed he'll finish his dinner in the next hour.

Will set an alarm in case I fall asleep before test and snack at +3 (he doesn't typically start dropping til at least then). I hope that number is good enough to let me sleep through; husband will be up by +7 or +8 to test again if so.

I'm sure I'll be confused again in the morning ... I assume I consider tonight's skinny 2 a token dose, and start up on the 2.5 tomorrow if BG and appetite is good?

Thank you so much for spending time with me today, you're so lovely to help us all; I'm incredibly grateful!
 
Aaawww. Sweet Nacho. He’s a very special guy. I am very glad he ate more last night. I think it was good to be cautious with the dose. Thanks for the kind words. Let me know how he is doing.
 
Suzanne & Darcy said:
Aaawww. Sweet Nacho. He’s a very special guy. I am very glad he ate more last night. I think it was good to be cautious with the dose. Thanks for the kind words. Let me know how he is doing.
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good morning! nacho was super spicy and hungry this morning -- he ate a good breakfast & didn't get too low overnight, so we gave him a 2.5 dose. unfortunately he was so spicy that most of the morning dose of miratzapine ended up all over his face and my pajamas... i hope enough got in to keep his appetite up for snacks, dinner, and PM dose
 
How is Nacho doing? I see he still is having appetite problems intermittently. Has the vet come to any conclusions on that?

I can’t remember if I have ever previously recommended the Visbiome Vet probiotic. It’s way better than Proviable Forte. I probably did because Nacho has IBD and my cat has IBD.

I really feel like he needs an abdominal ultrasound if this continues- to check intestinal thicknesses, etc. and did they ever do the Pancreatic Lipase test for pancreatitis?

Anyway, I just wanted to check in because I have been worried about Nacho.
 
Appetite is much better, working on the nausea and the diarrhea is almost cleared up. we're waiting to get a call from the internist that our vet called a referral into.

What would I look for on lab results to see if they did a pancreatic lipase test?

Once we're done with the full reginemnt of Proviable, I'll check out Visbiome; thank you for the suggestion!
 
Hi. I read this message and I forgot to reply about the pancreatitis test. It might say Snap fPL or Spec fPL or maybe something about pancreatic lipase (that’s the PL part. The f stands for feline)

how is Nacho today?
 
oh yes, they did do it! Spec fPL is exactly in the middle of the range.

nacho's doing ok! appetite is pretty much back to normal, stool is firming up although still occasional runs, and we're on day 6 of no vomiting :)

increased him to 2.5 this morning; 8 cycles on 2.25 without seeing him even hit 150

re: visbiome; can you provide a purchase link? I'm not sure if i'm finding the right one... unless it's vet RX only?
 
That’s good to know. Glad you increased. I was looking at his SS yesterday and thinking it was time. No vomiting is excellent!
 
Just make sure he’s eating well and watch him if it looks like he’s coming down rapidly from a pink to a yellow (or blue). We don’t want any more limes. I am hoping last time was due to him not eating properly or snacking.
 
I do not give more than one capsule per day. Maybe initially it would work faster if you do? Not sure.

I have also used the little packets - that’s what I am using now. They have even more CFUs.
 
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