Mork DX'd w/pancreatits, BG all over the place

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ngriffhawk

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Hi,
Mork has been diabetic since 2009 and on Lantus 2x day. He also has CKD so vet has him on Hills Mature Adult Active Longevity wet food 2x day. This cat is very hard to food control, he ALWAYS wants food. He is about 17lbs. Everything was going ok until about 2 weeks ago he stopped wanting food so we took him to vet. Also to mention, his sister Mindy passed away on 4/9/12, so we weren't sure if it was due to the loss or not. Tests came back positive for pancreatitis. Have been home testing but sugars are swinging wildly. (2 hypos in 10 days w/no symptoms, to in the high 400's)

The reason I'm posting is I can't seem to get it together to make a SS to figure anything out. The loss of Mindy has hit me incredibly hard and then to have a serious health crisis with another so quickly has fried myself and my husband. I have read all the info for beginners on the board, but I feel as if I am on info overload trying to figure out the FD, CKD and now the pancreatits. I am also super afraid of losing him so close to Mindy.

I apologize if this is off topic, but can anyone give me any advice to "reboot" and start over? Or how to handle all the info when overloaded? I feel as if I am not doing him any good right now and failing at handling his needs. Any instructions or advice no matter how simple would be greatly appreciated. Thanks in advance. I don't think I even have a signature, so will sign Nicole and Mork for now.
 
Hello Nicole,
I am very sorry to hear about your loss of Mindy, first of all. And I understand that right now everything is one big pile of chaos.

Can you tell us some more?
What's the current dose of Lantus Mork is getting?
I think that your immediate issue right now is the pancreatitis. What did they give you to treat that with? Has there been any improvement in that condition?
Is Mork eating okay?
Would you like help setting up a spreadsheet. That's not an immediate concern, but it would be a great help to have one so that the numbers can make more sense to you (and us) going forward.
I feel as if I am not doing him any good right now and failing at handling his needs.
Click to expand...
Please don't feel that way. You posted here, and that is in no way failing him! This is the best place in the world for you to find some help with this.

I am going to ask some Lantus folks to stop by and see if they can help....

Carl
 
I'm so sorry about the loss of Mindy. It really does sound like you're on overload.

We can help you get a spreadsheet (SS) set up. There are a number of folks who are computer savvy and can lend a hand.

Do you have any test data on Mork? If you list it out in columns here, we can begin to help you get things sorted out. Just let us know what will be easiest for the time being.

Let's take one thing at a time.
  • How did your vet suggest you treat Mork for the pancreatitis? I can give you links on pancreatitis if you want them.
  • Is Mork eating?
  • What food is he eating for the CKD and FD? Jill has a page on Alex's spreadsheet for low carb/low phosphorus foods.
  • Have you seen Tonya's website for cats with renal disease? If not, there's an incredible amount of good information there. There are lots of cats here who have kidney issues and/or have bouts of pancreatitis.

I'm hoping that your vet gave you pain meds for Mork. It is very likely that it's the pancreatitis that is effecting Mork's BG levels. Also, if Mork has dropped into low numbers but was asymptomatic, how low were the numbers? With the protocol we use to guide Lantus dosing (Tight Regulation Protocol), we look to see a cat drop into lower numbers as a means of determining if a dose reduction is needed. Since Mork is a longer term diabetic, if his BG numbers dropped below 40, you may want to reduce his dose by 0.25u. It's also not unusual for a cat that does drop into lower ranges to experience a bounce into high numbers. This is a normal, protective function of the liver. Just be patient. It can take up to 72 hours for a bounce to clear.

Please let us know how we can help.
 
Thank you for your kind responses. I will try and answer both of your questions as best as I can although it is very confusing.

What's the current dose of Lantus Mork is getting?
- Effective 5/9 we were given a chart to follow depending on what his BG is and how much he eats:
- If he eats at least 1/2 his normal amount and BG =
300+, give 4 units
250 - 300, 3 units
200 - 249, 2 units
less than 200, no insulin

- If he eats less than 1/2 his normal amount and BG =
300+, give 3 units
250 - 300, 2 units
200 - 249, 1 unit
less than 200, no insulin

I think that your immediate issue right now is the pancreatitis. What did they give you to treat that with? Has there been any improvement in that condition?
- We are giving him appetite stimulant (Mirtazapine 1/8 tablet every evening) & pain medicine (Buprenex .11mg/ml twice a day). His appetite & energy level have improved over the last two days.

Is Mork eating okay?
- His eating has improved over the last few days but it still takes a couple of hours to get him to finish his normal amount. He is still on the appetite stimulant and pain medicine.

Would you like help setting up a spreadsheet. That's not an immediate concern, but it would be a great help to have one so that the numbers can make more sense to you (and us) going forward.
- Yes, any help would be appreciated.

Do you have any test data on Mork? If you list it out in columns here, we can begin to help you get things sorted out.
- We started keeping track on 5/5 when we first brought him to the vet.
Date Time BG Insulin
5/5 4:14PM 39 Told to stop giving insulin completely. Gave syrup & food to bring up BG.
5/5 5:39PM 131
5/5 11:03PM 181
5/6 11:17AM 425
5/6 8:20PM 414
5/7 8:43AM 433 Called vet and was told to start giving 3 units twice a day, gave 3 units
5/7 12:00PM 378
5/7 9:00PM 408 gave 3 units
5/8 8:00AM 348 3 units
5/8 8:20PM 282 1 1/2 units (didn't eat enough)
5/9 8:08AM 212 none given, refused to eat
5/9 7:44PM 492 4 units (started using chart above per vet instruction) Note: switched vets due to lack of timely response to insulin dosing questions
5/10 7:30AM 292 2 units (didn't eat well)
5/10 6PM 162 BG tested at vet, gave 1 unit at 9PM per vet instruction
5/11 morning no testing, insulin, or food due to Ultrasound appt
5/11 8:00PM 308 4 units, began pain meds & appetite stimulant
5/12 9:20AM 403 3 units (didn't eat well)
5/12 9:40PM 204 2 units
5/13 10:00AM 446 4 units
5/13 8:50PM 287 3 units
5/14 8:13AM 52 gave syrup and food but didn't eat well, gave him cooked chicken bits
5/14 8:57AM 73
5/14 10:35AM 106
5/14 5:40PM 372 4 units @ 7:30PM
5/14 11:50PM 473
5/15 7:40AM 451 4 units
5/15 2:20PM 282
5/15 7:15PM 109 0 units
5/15 11:45PM 160
5/16 7:22AM 469 4 units
5/16 7:20PM 424 4 units
5/17 4:15AM 295
5/17 7:05AM 301 3 units
5/17 6:59PM 333 4 units
5/18 6:55AM 433 4 units
5/18 3:10PM 343
5/18 8:05PM 295 3 units
5/19 8:05AM 447 4 units
5/19 7:25PM 281 3 units
5/20 8:55AM 374 4 units
5/20 7:45PM 291 3 units

How did your vet suggest you treat Mork for the pancreatitis? I can give you links on pancreatitis if you want them.
- See above for meds & insulin dosing chart. Any links would be appreciated.

Is Mork eating?
- His eating has improved on the appetite stimulant but is still not 100%. Takes 2-3 hours to get him to eat his normal amount of 1/2 a can. Used to eat most of it in one sitting. He is supposed to eat 1 can a day, 1/2 in am and 1/2 in pm.

What food is he eating for the CKD and FD?
- He is on Hill's Mature Adult wet food Turkey flavor per vet instructions to manage both conditions.

Jill has a page on Alex's spreadsheet for low carb/low phosphorus foods.
- Do you have a link to this? Have been afraid to switch b/c vet said the Mature Adult food would be good for both conditions.

Have you seen Tonya's website for cats with renal disease? If not, there's an incredible amount of good information there. There are lots of cats here who have kidney issues and/or have bouts of pancreatitis.
- I have checked it out but I am very overwhelmed between FD, CKD and Pancreatitis. They all seem to contraindicate each other or just confuse me I'm not sure. I will go and reread over there!

Right now we are mostly concentrating on getting him to eat and stay hydrated. He seems to be drinking normally. We switched vets because the first one took him off insulin altogether and Mork seemed to get worse. They were not getting back to us when his BG bounced and stayed high. The next vet gave us that dosing chart for use during his pancreatitis. The doses seem to be large changes, so I am very nervous that by treating the pancreatitis, we are hurting the FD or the CKD at the same time. So I guess I was trying to figure out if I was at least going in the right direction because our case seems so different than others on here. Thank you again so much for your help.
Nicole and Mork
 
Maybe you should try Tight Regulation or SLGS instead of a sliding scale dosing method. That means you shoot a consistent dose with every shot instead of changing it each time. Lantus is slow release and has an overlap, so Lantus is meant to be dosed based on the nadir numbers (lowest point of the cycle) as opposed to preshot numbers. With Prozinc I believe you shoot based on the preshot. I think using the insulin properly will help you a LOT. You can read about the TR protocol here viewtopic.php?f=9&t=1581

That being said, you NEED to start getting mid cycle checks every day if you can, because you can't dose based on the nadir if you don't know what it is. Just testing at the preshots isn't enough. Please try to get at least one test between the 4-6 hour mark. That would help us to help you make sure your kitty is going to stay safe.
 
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