New guy - full house of issues (fd, panc, ibd, high bp +)

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Hi! My name is Ellen and my 15 y.o. cat is Redd. He was diagnosed with fd in April and is still unregulated. He has many other health issues that complicate things and I am starting to lose hope that we will ever get him regulated.

History - He has had IBD for 7 years but has been stable without regular meds for several years. He is on grain free wet food and takes a short course of flagyl when he has very rare flare ups. Last December he was diagnosed with high blood pressure and takes amlodopine 1/4 tab once daily. At the same time he was diagnosed with cardiomyopathy and takes atenolol 1/4 tab twice daily. In April, he had a major episode that was diagnosed as pancreatitis by ultrasound and diabetes by blood test. The pancreatitis cleared with fluids and pain meds after a week, but I should add that the ultrasound tech person said his pancreas was the most inflamed she had ever seen and that frequent flare ups are to be expected. We switched to a high protein, low carb grain free wet food (Wellness Core chicken) to address the FD and began insulin.

BG & Insulin - At the start his BG was hovering in the high 300's sometimes over 400 with stress or food spikes. We started at 1 unit of Lantus twice daily testing every 10-14 days with at-home curves. We hovered in the 300's for two months while increasing .5 units after each test curve. At 2.5 units, his curve finally dipped down to mid-high 200's and we increased to 3 units. The following week he had a pancreatitis flare up that sent his BG skyrocketing for a week, and that was followed by an IBD flare up the next week. Cue the buprenex, cerenia, and flagyl. Once that all cleared, his BG curve was back in the mid 300's so his vet upped the insulin to 3.5. I just did his 14 day curve today and it's actually worse with preshot numbers around 400 and peak number around 350. I'm going to repeat the curve tomorrow in case I goofed it up somehow.

What is going on? I'm getting frustrated and impatient and fighting hopelessness. The only things that changed this week were two suggestions from my vet to try to prevent future ibd flare ups - cerenia 1/4 tab twice a week and omega 3 fish oil once daily. Could these have raised his BG? I already know that the atenolol can make regulation tricky but my vet said that it would be worse for him to go without it. How high can we go with the insulin? Does anyone have hopeful stories about their own multi-issue cat.

Thanks! -Ellen
 
Re: New guy - full house of issues (fd, panc, ibd, high bp +

Boy, you sure do have a full plate of issues, but that's OK; a way can be found to juggle them and bring down the BG and have less flares of the other issues.

For the pancreatitis, I did not see that you are giving subQ fluids at home - one of mine, Shadoe, has frequent bouts of pancreatitis, and the normal treatment for her is bupe for pain, along with fluids 100ml min per day, and also I give her 1/4tab of regular strength Pepcid twice a day BID - max daily dosage for cats is 5mg so I get the 10mg and cut in 4. I have found that giving her Pepcid with am and pm shots help to keep her stomach settled, so maybe you can ask your vet if it is OK for Redd.

For the insulin, what kind of insulin are you giving as it will make a difference in the advice and suggestions people give you. As for how high a dose can go, that would depend on the cat and Redd's current dose is not that high. There are insulin resistance conditions that would require higher doses, but you are not even close to that area yet at all!

If you are home testing, you can test more regularly and be able to see how the insulin is working - no need to wait for 10days to do a curve. Many people test before each shot, before bedtime and then a few other times during the day. Just like human diabetics, it's good to test a bit more to see how the numbers are changing.

I cannot comment on the effects of Redd's meds on his BG as I have no experience in that regard. The few times I have given flagyl, there were no changes in BG other than maybe down as my cat got better. The same goes with any others I have given like zeniquin right now for Oliver.

Never lose hope that you will get Redd regulated ... that's not possible. If you carefully raise his insulin dose, and slowly in small increments, there is no reason why you should not find Redd's good dose... it could be 3u or 5u or even higher, but you will get to a dose and everything will start to fall into place. He will start to act better and look better, and then you will start to see improvement in his BG numbers. I do know that when Shadoe's pancreatitis clears, her BG comes down, as pain has some effects on numbers too.

If you could put Redd's BG numbers from tests and curves into a google spreadsheet as others on this site use, you will be able to see how Redd's doing on the doses, and the sheet will also give others access to the data and be able to help you in direction.

I am not sure if you have read the protocol many here are following -

Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Lantus & Levemir: Info, Proper Handling & Storage has picture of syringe and insulin pens.

It may take some juggling, but you will get Redd regulated.
 
Re: New guy - full house of issues (fd, panc, ibd, high bp +

Thank you for the support and advice! I was having one of those late night panics after a day of bad BG numbers. Today's numbers look somewhat lower and flatter so I feel a little better.

I will be sure to ask for subq fluids the next time his pancreatitis flares up. I'm not sure why they gave us that the first time but not this last time. Redd is on Lantus and I'm glad to hear that 3.5 isn't that high a dose. I do spot checks and partial curves in between full test days but I never really know what to look for with fewer tests. I'm definitely going to review all the info here to get more familiar with the best times for spot checks and how to interpret the results. I am also putting together my spreadsheet today. Thank you again for all the info and suggestions!

Ellen and Redd
 
Re: New guy - full house of issues (fd, panc, ibd, high bp +

the spot checks can be done at +5,+6,+7 after an insulin shot
 
Re: New guy - full house of issues (fd, panc, ibd, high bp +

Please be sure that you know you can vent and panic anytime you want here; someone will help you along, with support or whatever you need.

The fluids are so easy and super important for pancreatitis treatment; I always have a bag of fluids and needles because pancreatitis comes on fast, and flares don't wait for you to run to the vet for fluids!
I have a feeling that some cats have frequent problems with pancreatitis so you may as well be stocked.... have your fluids, your pepcid, and your pain meds of choice. Don't wait to get the fluids in the house.... that's like running to the pharmacy when you have a migraine to buy some aspirins!

If I get a hint from Shadoe, like licking her lips or shying back from food, or meatloafing, she gets her pepcid, then if no improvement in a short while, I try a bit of bupe. If her scruff does not snap back well, and her BG are not too low, I can give her some fluids. Because some cats drop lower from fluids, like my Shadoe, you want to give fluids at times that don't interfere with nadir or when numbers are too low.

Lantus is a great insulin and I am sure that once you have your spreadsheet together with some data, there are tons of others over in the Lantus group who can help you decipher the numbers you have been getting.

I am glad that you are seeing better flat numbers today.
 
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