New member - help needed / questions

[TommyTheCat]

We are looking for help on what to do for our cat. After spending $11K on recent ER care, we are limited on what we can afford to do next. Questions are numbered throughout message below.

Background & Initial Hospitalization:

*Dental History: Had almost all of his teeth extracted 2 months ago. He was eating well shortly after the procedure, but started becoming picky with food until he was eating less and less. While we were gone on vacation he barely ate at all, leading to severe illness and an emergency room admission.

*Initial Diabetes Diagnosis (July 20, 2026): Hospitalized for anorexia, lethargy, and jaundice. Diagnostics revealed feline triaditis (pancreatitis, cholangiohepatitis, and enteritis) along with secondary diabetic ketosis/DKA (BG 352), elevated ketones 4.1

*Hospital Care: Treated with IV fluids, antibiotics (Unasyn/Clavamox), an insulin CRI. An esophageal feeding tube was placed prior to discharge.

Current Status
*Clinical Improvement: Tommy is acting much brighter and has been eating on his own (now it’s the opposite problem with a ravenous appetite), so tube feedings are no longer being administered (feeding tube is still in)

*Current Diet: weight has remained stable since his ER admission (being monitored).
He is eating Fancy Feast Classic Pate only (no dry food or other additions), and is being fed whenever he is hungry which feels like it’s way too often.

Question 1: Is it ok to be feeding so much? He’s eating 6-7 cans a day (and would eat more if we let him).

Medications Discontinued: Anti-nausea meds, gabapentin, and appetite stimulants (mirtazapine) have been stopped.

Lab Status: Follow-up labs at ER showed overall improvement with most of his issues (4 days after discharge), and overall things appear to be moving in the right direction.

Current Challenges:
Insulin Non-Responsiveness / Consistently High Glucose

Current Protocol: Glargine (Lantus) given via U-100 syringes, currently dosing .2 units, every 12 hours

However, his blood glucose readings remain extremely high.

I attached readings from when the freestyle libre was working (and he was at .1 and .15 units of lantus).

Libre stopped working. We have just started to test on the ear instead. I see that we are supposed to make an excel sheet, which I will figure out soon. In the meantime…
Readings:
7/30
10pm 376 *1st test using blood from the ear

7/31
7:25am 363
7:30am .2 insulin given
12:30pm 324
7:20pm 432
7:30pm .2 insulin given
Had a few failed test attempts that night. The machine kept reading error.

8/1
7:20am 360
7:30am .2 insulin given
12:15pm 351
7:25pm 403
7:30pm .2 insulin given
10:00pm 379

8/2 gave ears a break and didn’t test. Worried we are hurting him. .2 insulin given at 7:30am & 7:30pm

8/3 7:25am 310
7:30am .2 insulin given
12:30pm 349

He eats prior to insulin. And constantly!… which may be messing up our number but we don’t know what else to do.

Question 2: His ears are so red from where we have been poking his ears. Worried we are hurting him and not sure if we should be re-poking the same red spots or not?

Can anything be done to help or improve the redness?

But the bigger issue is: There is still no clear drop or proper nadir following insulin administration! Based on the libre (the ear tests are still new for us). See attached screenshots from when the libre was still working and not just reading HI all the time like it does now.

Question 3: what protocols or adjustments have others seen work when a cat appears completely non-responsive to Lantus post-DKA/triaditis?

We moved insulin dose from 0.1 to 0.15 (both when we were using the libre only) to 0.2 (the same day we started manual testing on 7/30/26) without guidance from the vet. This is because we did everything at an ER and spent all of our money. We will find a primary vet when our next paycheck comes. This .2 dose has been held steady since 7/30 PM.

Question 4: How long do we stay at this dose and how do we handle dose increases safely?

Persistent Diarrhea- he has developed loose stools/diarrhea over the last 4 days (with very strong odor).

Tried: FortiFlora and pumpkin, with no improvement.

Question 5: What dietary adjustments, specialized probiotics, or over-the-counter anti-diarrheal strategies are commonly recommended for post-triaditis/diabetic cats with this added GI issue?

Overall we aren’t sure what we should be doing in regards to insulin dosing, along with how to properly manage feeding schedules (and constant need for food) to balance keeping him satiated and maintaining his weight, while his glucose levels remain unregulated.

Any help would be greatly appreciated.

We plan to see a vet to have the libre and feeding tube removed, along with asking for guidance either this Friday when our next paychecks come, or the following Monday (depending on availability).

 

[Christina&Pants]

Pinging @Wendy&Neko for Lantus-oriented newbie support

Glad to hear your Tommy seems to be recovering. S. Boulardii was recommended to me as a probiotic through other members here and I had good results with it. I think it's used often with IBD kitties. Fortiflora never cut it for my boy Pants, Proviable Forte did very little, pumpkin moved the needle. S. Boulardii was decently helpful but expensive for its shelf life and my ADHD -- kept leaving it out of the fridge by mistake. My vet ended up prescribing us Nutramax Proviable Fiber Supplement With Prebiotics Powder, which has worked the best for Pants most recently. All options worth exploring. My Pants has not had triaditis nor IBD, but he is diabetic and has loose stool issues with nearly any change in diet or meds

May I ask why Tommy almost all of his teeth to be extracted? If it was due to stomatitis or inflammation... I'd be worried that the rest might need to come out too. May be worth keeping an eye on his mouth condition throughout your other care just to be safe, dental issues can definitely cause high glucose.

Sending much love. When Pants had to get transfusion and FIP treatment, I ended up having to open a credit card under one of those "no interest for 18 months" deals to give me the wiggle room to get him the care he needed

 

[CORKY]

here is how to create a spreadsheet and your signature, I will tag a member that can assist you with Lantus dosing as well

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Sticky - New? How You Can Help Us Help You!
if you have difficulty with the spreadsheet, we can help you create it, it will be downloaded on GOOGLE DRIVE

 

[Wendy&Neko]

Question 1: food topic. Post DKA, you are OK to feed him 1.5 times his normal calories. Happy to hear he's eating well without the anti nausea and appy stimulants! Is he back to his normal weight yet? Any idea what caused the enteritis?

Question 1, different topic, this time on dosing. How are you measuring the 0.1 and 0.2 units of Lantus? We use U-100 3/10cc syringes with 1/2 markings. Which means we can eyeball 0.25 unit changes. Can you give us the name/brand of your syringes or a picture with it loaded to his current dose?

Question 2: Are you holding the poke spot for a while after getting blood? You can also put a cool face cloth on it. More ideas on poking and ear care in this post: Testing and Shooting Tips

Question 2 on BG numbers you are seeing. Please get information in the spreadsheet, that'll really help us to help you. Give us a shout if you have technical problems. I also need to know how you are measuring your doses.

Questions 3 - we have two different dosing methods we use here. Take a read of this Sticky Note Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) and see if you'd like to follow one of them. We have had all sorts of different cats and conditions that have followed one or the other of these methods.

Question 4 - question on dosing - fill in the spreadsheet and answer question on how you are measuring doses so we can help. Plus let us know if you want to follow one or the other of the dosing methods. That information guides our answers.

Question 4 on diarrhea - in addition to s. boullardi, a prebiotic and general purpose probiotic can help. Psyllium husk fibre is a good prebiotic, start with a pinch AM and PM.

Question 5 - partly answered above. First step is find out what caused the enteritis. If it is IBD, then a novel protein diet can help. This website has lots of information: IBDKitties – Helping Save Lives…One Paw at a Time. and has a section on supplements and probiotics. I liked Visbiome for my IBD girl. CDS22-formula is the equivalent in the UK and Europe.

And a question of mine. Is the vet assuming IBD? Has an ultrasound been done? Wondering how they diagnosed enteritis. Small cell lymphoma is another diagnosis that can look a lot like IBD and needs a biopsy to differentiate. Or if the novel protein diet works, it is probably IBD present. Though you can have both. Note, steroids such as prednisolone or budesonide may be need in stronger cases of IBD, sometimes for life. For small cell lymphoma, a short course of steroids may be needed. Prednisolone can impact blood sugar values.

 

[TommyTheCat]

Pinging @Wendy&Neko for Lantus-oriented newbie support

Glad to hear your Tommy seems to be recovering. S. Boulardii was recommended to me as a probiotic through other members here and I had good results with it. I think it's used often with IBD kitties. Fortiflora never cut it for my boy Pants, Proviable Forte did very little, pumpkin moved the needle. S. Boulardii was decently helpful but expensive for its shelf life and my ADHD -- kept leaving it out of the fridge by mistake. My vet ended up prescribing us Nutramax Proviable Fiber Supplement With Prebiotics Powder, which has worked the best for Pants most recently. All options worth exploring. My Pants has not had triaditis nor IBD, but he is diabetic and has loose stool issues with nearly any change in diet or meds

May I ask why Tommy almost all of his teeth to be extracted? If it was due to stomatitis or inflammation... I'd be worried that the rest might need to come out too. May be worth keeping an eye on his mouth condition throughout your other care just to be safe, dental issues can definitely cause high glucose.

Sending much love. When Pants had to get transfusion and FIP treatment, I ended up having to open a credit card under one of those "no interest for 18 months" deals to give me the wiggle room to get him the care he needed

I can’t remember the exact reason for the teeth. The vet just said they were inflamed and causing pain so all of them were removed, except for his incisors. That was another $4K. It’s been insanely expensive. Thanks for the advice!

 

[TommyTheCat]

Question 1: food topic. Post DKA, you are OK to feed him 1.5 times his normal calories. Happy to hear he's eating well without the anti nausea and appy stimulants! Is he back to his normal weight yet? Any idea what caused the enteritis?

Question 1, different topic, this time on dosing. How are you measuring the 0.1 and 0.2 units of Lantus? We use U-100 3/10cc syringes with 1/2 markings. Which means we can eyeball 0.25 unit changes. Can you give us the name/brand of your syringes or a picture with it loaded to his current dose?

Question 2: Are you holding the poke spot for a while after getting blood? You can also put a cool face cloth on it. More ideas on poking and ear care in this post: Testing and Shooting Tips

Question 2 on BG numbers you are seeing. Please get information in the spreadsheet, that'll really help us to help you. Give us a shout if you have technical problems. I also need to know how you are measuring your doses.

Questions 3 - we have two different dosing methods we use here. Take a read of this Sticky Note Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) and see if you'd like to follow one of them. We have had all sorts of different cats and conditions that have followed one or the other of these methods.

Question 4 - question on dosing - fill in the spreadsheet and answer question on how you are measuring doses so we can help. Plus let us know if you want to follow one or the other of the dosing methods. That information guides our answers.

Question 4 on diarrhea - in addition to s. boullardi, a prebiotic and general purpose probiotic can help. Psyllium husk fibre is a good prebiotic, start with a pinch AM and PM.

Question 5 - partly answered above. First step is find out what caused the enteritis. If it is IBD, then a novel protein diet can help. This website has lots of information: IBDKitties – Helping Save Lives…One Paw at a Time. and has a section on supplements and probiotics. I liked Visbiome for my IBD girl. CDS22-formula is the equivalent in the UK and Europe.

And a question of mine. Is the vet assuming IBD? Has an ultrasound been done? Wondering how they diagnosed enteritis. Small cell lymphoma is another diagnosis that can look a lot like IBD and needs a biopsy to differentiate. Or if the novel protein diet works, it is probably IBD present. Though you can have both. Note, steroids such as prednisolone or budesonide may be need in stronger cases of IBD, sometimes for life. For small cell lymphoma, a short course of steroids may be needed. Prednisolone can impact blood sugar values.

He has not returned to his normal weight yet but he is maintaining the same weight. He’s still a little more than 1.5 lbs under what he was when this first started. We are giving way more than 1.5 times his normal calories. Should we cut back? He just seems like he’s starving at all times.

To be honest, I don’t even know what enteritis is. They did an ultrasound. I’m attaching the results but I don’t know what it says. It’s very confusing. They threw a lot of information at us but we were only told to focus on the diabetes and follow up with an internist, which we haven’t done yet since we spent most of our savings on the hospital bills. We plan to bring him to someone next week.

If you can make sense of the report, please let me know. I never heard anyone say IBD, but I could be wrong. Do you think we should be asking for steroids?

I attached the needle we are using and showed where it currently is for dosing. The second line.

We will work on the spreadsheet tonight.
While we would prefer a faster route, testing is still a struggle for us and I’m not sure we could do more than we currently are. So I think that means we will need to do SLGS. For now.

I hope I answered all of your questions. This is a bit overwhelming. Thank for your detailed reply and help!

 

[Wendy&Neko]

You are currently giving 2 units of insulin. This is a picture of how syringes could be marked, with the left one showing half unit markings.

More information about pancreatitis here: A Primer on Pancreatitis. It is painful. Is he on any pain meds?

IBD = inflammatory bowel disease, which is one option mention in the ultrasound report. The other being lymphoma, though they though IBD more likely. You can't really tell from an ultrasound.

If Tommy isn't back to his ideal weight yet, feed him what he wants.

 

[TommyTheCat]

You are currently giving 2 units of insulin. This is a picture of how syringes could be marked, with the left one showing half unit markings. View attachment 79771
More information about pancreatitis here: A Primer on Pancreatitis. It is painful. Is he on any pain meds?

IBD = inflammatory bowel disease, which is one option mention in the ultrasound report. The other being lymphoma, though they though IBD more likely. You can't really tell from an ultrasound.

If Tommy isn't back to his ideal weight yet, feed him what he wants.

He was on gabapentin but we stopped giving it to him. Should we start that again? It doesn’t seem like he’s in pain, but maybe he’s just good at hiding it? I certainly don’t want him to be in pain. Gabapentin feels like more of a sedative than a pain med but please let me know if we should resume that. Or how can we tell if he needs it? I can ask about a pain med when we go to the vet next week. Maybe a buperenex type med would be better… I had my last cat on that for many years

 

[Wendy&Neko]

This post has some picture that tell you what pain looks like:

• Feline Pain Scale

It does seem that vets tend to give gapapentin more readily than buprenorphine these days. If he's eating fine and back to regular behaviour, he may be over the pancreatitis.