? Low BG due to not eating much?

Mochi has issues with inappetence. We started Cerenia at the end of last week, 1/4 16 mg tablet once a day, and it seems to be helping. The directions said to give it 4 days in a row and then 1 day off. Yesterday was our first day off and Mochi's did eat much at all. Maybe 3/4 of the half a 5 oz can of food that I gave him in the morning. Consequently his BG numbers went really low yesterday/last night.

Every time I get close to raising his insulin dose, he has one of these low appetite days and he drops below 50 which is an automatic dose decrease for both SLGS and TR. It's making it nearly impossible for me to regulate him as I'm constantly increasing his dose, and then decreasing it again before the week is up. I really don't think that 1 unit is enough for him and I don't want to drop him back down, but 1.25 keeps pushing him too low when he doesn't eat.

I'll be updating the vet with his numbers today and probably hear back from him tomorrow, but I wanted to get some input from here too. I'm hoping that more experienced eyes can help me figure out what's going on.

 

Is he still on the pred (I'm assuming so given the IBD Dx)? I suspect that's more the issue than the inappetence, makes things a bit unpredictable.

You're doing everything right in terms of dose and monitoring, but have you isolated the cause of inappetence? Pancreatitis? Or just the IBD?

If he isn't actually vomiting, ondansetron is a better choice for just nausea. Have you tried appetite stimulants?

Sometimes they get higher if theyre constipated/a little backed up, and then drop lower after they go.

 

Yes, he is still on the pred. We are assuming that the inappetence is due to the IBD, but an ultrasound a few years back did show signs of potential chronic pancreatitis. The vet, however, doesn't seemed all that concerned about it. Not sure why? He was vomiting a lot prior to the pred, but now it is rare. The vet classified Cerenia as an appetite stimulant and I do see that it can be used that way despite it primarily being an antiemetic drug. We tried it in the past for his vomiting and it didn't do anything, but it seems to be helping with his appetite now.

 

Pancreatitis care really is just treating symptoms, so usually a cocktail of Cerenia, ondansetron, appetite stimulant like mirtazapine or cyproheptadine, and pain meds like buprenorphine or gabapentin, fluids if dehydrated. So not all that different from what you're doing.

It might be worth keeping an appetite stimulant on hand for days like that. I don't think it will solve your dose/BG fluctuation problem, but nice to have.

FYI @Katherine&Ruby 's Ruby is similar if you look at SS. She has SCL but is on pred. I've seen quite a few pred spreadsheets like this now.

 

And now we're down to half a unit. One quarter unit after tonight's dip if I stick with SLGS. If this keeps up, he'll decrease himself right off the juice and I don't think he's ready for that.

 

I'm going to tag @Wendy&Neko for her opinion.

What is your current feeding schedule? Often tweaking that can help keep them flatter, but unfortunately it only works if they eat somewhat reliably...so if she's still inappetent it may be difficult.

Sometimes splitting the pred BID helps

 

I give typically give him half a can in the morning after his shot. Some days it's gone by +2, other days by +4, but it's not uncommon for there to still be food in his bowl, untouched, by +6 or even later. I refill it whenever he finishes it, so he always has something to nibble on. I try to make sure he's got something in his bowl before I go to bed. Sometimes he eats it, sometimes he doesn't.

I've tried giving him smaller amounts (1/3 or 1/4) more frequently, but it didn't seem to make much difference.

He is already taking the Pred twice a day at shot time.

 

Can I ask how much Mochi weighs? It sounds like the Cerenia dosing is wrong. Many vets underdose it. 4mg would be suitable for about a 4 lb cat, it's about 1 mg per lb of cat. Plus you can give it every day, stopping a day is old school. Table 9, page 232 of this article shows the current standards for dosing cats for inappetance. (2016) ISFM Consensus Guidelines: Diagnosis & Management of Feline Chronic Kidney Disease

I'm just wondering if you can get him eating properly if that would change how you dose him. Many people find ondansetron is actually a better drug for inappentance due to GI issues. Cerenia is better at stopping vomiting.

If you are going to stick with SLGS, could you update your signature to say that. It's usually better to be a bit more aggressive with a cat that has fallen out of remission. If you could do it, TR would be better. But I agree with you that he doesn't look ready to go off of insulin or that low a dose yet.

Out of curiosity, have you ever had his B12 or folate levels tested? If he needs it, B12 supplementation could help.

 

He's hovering around 10.5 pounds. The vet did say that I could give the Cerenia every day. He is out of town this week, so I won't be able to talk to him about the dosing until next Tuesday at the earliest. He is already on a B12 supplement (oral).

I have decided to attempt tight regulation, I'm just a tad bit (okay, a lot) nervous about dosing him when he's under 200 at night because of how easy and how often he goes really low.

 

Sounds like you could easily double the Cerenia dose, that might help the appetite You can actually give ondansetron as well, they target different nausea receptors.

Oral B12 supplementation doesn't work as well as injected when kitty has a compromised Gi system.

 

I'll ask the vet about rechecking his B12 levels, Cerenia dosing, and possibly adding another med to help with his appetite when I finally get to talk to him. I've been sprinkling his food with Forta Flora but it doesn't seem to help all that much. Is there anything else I can try in the mean time?