VitaminZosyn
Member Since 2026
Hi everyone! I’m a Internal Medicine resident (humans) and am really grateful to have found this group and see all the excellent support and advocacy here!
Medical Background
Leo (9 almost 10 year old buff tabby) has chronic pancreatitis, intermittent liver enzyme elevations, and a history of nausea and appetite changes. He has lost about 2 lb over the past few months which we think was in the setting of a pancreatitis flare vs diabetes. In July, his glucose was around 400, and fructosamine testing confirmed diabetes. He has also been taking prednisolone 5 mg daily, which may have contributed. He maybe has been making bigger urine clumps and has some polydipsia but nothing to write home about. Polyphagia is something I wish he had in a way given his chronic inappetence and subsequent food aversions.
Current Diet
Leo eats mostly dry food (Purina EN now, its been a roller coaster to get him to eat and he just started eating this well) and is accustomed to grazing throughout the day given my schedule. I have tried to do wet food only diets (post dental, in the midst of a flare) but he usually only eats about 15–20 grams at a time and so short of q2h feeding there was no way to get him enough calories. I bought a ton of different wet foods with his inappetance- it's been hard finding something that will not irritate his pancreas more, address his inappetance, and have him eat more than his 15 calories. He does not predictably return to wet food. I initially thought this might be because he grazes, but he eats similarly small amounts of wet food even when he is hungry like after fasting for an ultrasound. He has a sister who shares the same diet with him, she has a remote hx of pancreatitis but no chronic issues at this time and is happy to try all the new foods to make sure they're safe lol.
Medications
His main relevant medication is prednisolone 5 mg daily which we are discussing weaning (last time he flared despite a slow taper though the timeline of taper <-> flare isn't the cleanest). He also receives medications for nausea or appetite support as needed (cerenia, mirataz, zofran). It's always hard to tell what works and what doesn't, and I hesitate to do elimination tests of these medicines given the guy struggles to get his calorie amounts as is.
Insulin & Monitoring
Leo is currently prescribed 1u Lantus BID. His FreeStyle Libre 2 Plus worked for only about an hour before falling off. His readings were around 390–400. Based on those readings, my vet advised me to give his first 1-unit dose. That was 7 PM and I don't feel comfortable giving subsequent doses without being able to check his glucose. I had hoped to use a CGM for glucose trends and remote monitoring, but did order a POC tester and will set up the FDMB spreadsheet.
My residency schedule is one of my biggest concerns. Some days I leave around 6 a.m. and don't come home until 9 p.m. During other weeks, I work only night shifts from 7p-8a; or 8p-10a. My wife can help with some feedings, but insulin administration and glucose testing will primarily be my responsibility as he's too big for her and she's currently far along a pregnancy.
My biggest questions are:
Thanks in advance to everyone!
Medical Background
Leo (9 almost 10 year old buff tabby) has chronic pancreatitis, intermittent liver enzyme elevations, and a history of nausea and appetite changes. He has lost about 2 lb over the past few months which we think was in the setting of a pancreatitis flare vs diabetes. In July, his glucose was around 400, and fructosamine testing confirmed diabetes. He has also been taking prednisolone 5 mg daily, which may have contributed. He maybe has been making bigger urine clumps and has some polydipsia but nothing to write home about. Polyphagia is something I wish he had in a way given his chronic inappetence and subsequent food aversions.
Current Diet
Leo eats mostly dry food (Purina EN now, its been a roller coaster to get him to eat and he just started eating this well) and is accustomed to grazing throughout the day given my schedule. I have tried to do wet food only diets (post dental, in the midst of a flare) but he usually only eats about 15–20 grams at a time and so short of q2h feeding there was no way to get him enough calories. I bought a ton of different wet foods with his inappetance- it's been hard finding something that will not irritate his pancreas more, address his inappetance, and have him eat more than his 15 calories. He does not predictably return to wet food. I initially thought this might be because he grazes, but he eats similarly small amounts of wet food even when he is hungry like after fasting for an ultrasound. He has a sister who shares the same diet with him, she has a remote hx of pancreatitis but no chronic issues at this time and is happy to try all the new foods to make sure they're safe lol.
Medications
His main relevant medication is prednisolone 5 mg daily which we are discussing weaning (last time he flared despite a slow taper though the timeline of taper <-> flare isn't the cleanest). He also receives medications for nausea or appetite support as needed (cerenia, mirataz, zofran). It's always hard to tell what works and what doesn't, and I hesitate to do elimination tests of these medicines given the guy struggles to get his calorie amounts as is.
Insulin & Monitoring
Leo is currently prescribed 1u Lantus BID. His FreeStyle Libre 2 Plus worked for only about an hour before falling off. His readings were around 390–400. Based on those readings, my vet advised me to give his first 1-unit dose. That was 7 PM and I don't feel comfortable giving subsequent doses without being able to check his glucose. I had hoped to use a CGM for glucose trends and remote monitoring, but did order a POC tester and will set up the FDMB spreadsheet.
My residency schedule is one of my biggest concerns. Some days I leave around 6 a.m. and don't come home until 9 p.m. During other weeks, I work only night shifts from 7p-8a; or 8p-10a. My wife can help with some feedings, but insulin administration and glucose testing will primarily be my responsibility as he's too big for her and she's currently far along a pregnancy.
My biggest questions are:
- How should I handle Lantus when Leo eats only 15–20 grams of wet food at a time? What is the minimum food he needs to eat to get the shot?
- Does his dry-food grazing need to change immediately, or should we transition gradually while monitoring him? I read in the FAQs (and agree) that we shouldn't rock the boat, I think part of me is delusionally wanting to get him into remission asap
- What should I use as my “do not shoot” number while I am new and still collecting data?
- Is it reasonable to hold his next dose if I cannot check his glucose?
- How can I dose and monitor safely around 6 a.m.–9 p.m. workdays and weeks of night shifts? I have considered hiring a vet tech/sitter but the costs will add up; I'm willing to do it if needed.
Thanks in advance to everyone!
