New Member looking for advice and support

Hi all,

Glad to have found this forum. My cat Oberon (about 10 years old, indoor only) was diagnosed in early December after showing symptoms- weight loss, increased appetite, and elevated fructosamine, etc. I switched him from dry Science Diet Light to canned Fancy Feast pate, and that pretty much immediately brought his glucose levels under control. We had started him on Lantus (1 unit 2x/d), but stopped after about 2 weeks since he was in remission with the diet change. I have three other cats (two about 10 years old, one just over a year) who were still eating Science Diet, and every so often Oberon was still sneaking some, though he preferred the canned food. So in March I switched everyone to dry Young Again Zero plus the canned Fancy Feast. (I know the arguments against dry food and I'm considering switching completely over to canned; it's a work in progress.) I wasn't bothering with glucose checks (in retrospect, I should have at least been doing some spot checks). Everything was going fine until a few days ago.

Around Thursday evening or Friday morning his appetite decreased and he was acting like he wasn't feeling well. A bit quieter than usual and not bullying the other cats. (He's a jerk.) Sunday morning I checked his glucose and it was 359, and his weight was down about a pound from a couple of months ago. I emailed the vet to ask if I should consider giving him insulin; I still have the Lantus in the fridge from December. He said to hold off but definitely bring him in on Monday. So Monday morning I took him in. Turns out he has mild pancreatitis. So he was sent home with 4 days of Cerenia (anti-nausea) and Mirataz (appetite stimulant) while they ran additional blood work. I also asked the vet to check fructosamine again, and heard today that it was 845, and there was also glucose in his urine. So he's definitely out of remission. The vet doesn't want to start messing with insulin until we get the pancreatitis under control, though. The current plan is to do the Cerenia and Mirataz for 4 days, and see if his appetite comes back and he seems to be feeling better. The vet wants me to check blood glucose every morning this week, and then check in with him on Monday or Tuesday to decide what to do from there.

As of this morning his appetite is already better, though he still seems a bit down. Any thoughts on things I could be doing in addition to the vet's plan? Obviously if he looks like he's getting worse I'll call or take him in right away.

 

Hi Lisa and Oberon. Welcome to FDMB.

I have never had a cat with pancreatitis, so I have reached out to members on the Lantus forum to come advice you. My gut says that you should start insulin again to avoid DKA, but you may want to wait until you hear from some of the other members.

 

I wouldn't wait on starting the insulin. You would be putting him at risk for developing ketones. Do you have a ketone meter or urine strips?

I had a cat with pancreatitis. The treatment is usually cerenia for nausea, bupe for pain, and daily sub q's at home for a few weeks. With this treatment my cat was feeling better quickly and was totally himself after a week. So I would ask about adding sub q's to the treatment plan. I hope he's feeling better soon!!! This is my favorite how to give sub q's video in case you never did them.

 

Hi and welcome!

Waiting to start him on isulin may or may not be a good idea it all depends on what test results you are looking at, a pancreatis flair can raise the numbers and those could come a bit down as the flair is controlled, which would mean you may need to be adjusting doses accordingly but id doesn't mean you can't give insulin and it will probably help him feel better and as they mentioned above avoid more complications as developing ketones to better see how he's doing if you could please post the tests results you are getting that could help

 

Thanks! Janet, I don't currently have a way to check ketones. Are the strips/meter OTC, or do you need a prescription?
I'll post new numbers as soon as I check again.

 

Hi... The strips for the urine can be found in any pharmacy. They are cheap too, but you have to catch your cat peeing. If they are box stealthy like mine, the blood ketone is easier. They MAY sell it in Walmart or a pharmacy... I got one on amazon. I use the keto MOJO meter. It's gotten a little pricy though. The ketosens got good reviews, too.

 

Hi Lisa and Oberon! As you can see youve already received EXCELLENT advice. These folks are some of our very best!
I just wanted to welcome you and Oberon
You may want to set up a signature and a spreadsheet and you can find that info here:
Suggestions, Tech Support & Testing Area
These are very important and will help us help you navigate this disease. Please check it out!
If you look at the bottom of these fine folks post thats their signature. You need one too.
The spreadsheet will help our experts track how the insulin works for Oberon.

Again WELCOME TO FDMB The place to get answers!
jeanne

 

You might want to read the Primer on Pancreatitis. There are other things you can do to support the Pancreatitis like pain meds and fluids.

 

Thanks, everyone. I've made a spreadsheet and added the link to my signature file, so you can see the history. (Lots of details in the Remarks column.) I haven't gotten a glucose measurement today. I have the world's most tolerant cat; he lets me poke him repeatedly. But I'm still getting the hang of it and I'm having trouble actually hitting the vessel. I'll give it another shot later tonight. I tried doing it by hand once with just the lancet and I think that may work better for me in the long run, but I need more practice.
ETA: I'm also going to call the vet's office in the morning and ask them to send me his full labs so I have the details there.

 

It's great that you already have the spreadsheet up an running, congratulations!!!

Keep trying with the testing it gets easier with time and I do poke free handed without the lancet device I find that I can control it better and my cat doesn't get startled by the clicking sound

We have little data to know what's going on but that one test that you got is a bit high so starting insulin as soon as possible may be best and as long as you are home testing you can keep him safe and adjust the dose as he needs

 

you're doing great! It's a lot to wrap your mind around. When you test, don't aim for the vein... You want to aim for the sweet spot.

 

Ah, so between the vein and the edge of the ear? Maybe that's been my problem.

 

Yes.

 

OK, BG this morning (after breakfast) was 235, so that's not awful. Got the full labs from the vet this morning. Glucose then (Monday morning) was 370, urine was 3+ for glucose, negative for ketones, 3+ for protein. PrecisionPSL was 31 (normal is 8-26), consistent with pancreatitis but barely out of the normal range. His appetite is good this morning. The lancets I've got are apparently 33 gauge; no wonder I'm having trouble. Might try a slightly larger size to see if it's easier.

 

Just wanted to say Oberon is ADORABLE ! Please give him some scritches from all of us.

 

Oh yeah, 33 gauge lancets are really thin. Get some 28 guage. these are the ones I use. https://www.amazon.com/TruePlus-Ste...words=trueplus lancets&qid=1594822991&sr=8-18

235 is an awesome preshot! Make sure you are testing BEFORE feeding though or it might show as safe to shoot when really her numbers are food influenced and she's much lower.

 

OK, making some progress here. The 28 gauge lancet (and doing it by hand) made all the difference. I was also sometimes jumping the gun and adding the drop to the strip before the meter was ready, so I'd get an error code. I think we've got the bugs worked out now. Next we need to work on timing... my husband gets up early and feeds the cat, so by the time I get up and do BG Oberon has already had breakfast. So here are the numbers from the past two days, keeping in mind that they are not pre-breakfast numbers. 7/17 1:15 pm: 316. 7/18 9:15 am: 295. Next step: teaching my husband to do the testing so we can get pre-breakfast numbers. He's totally comfortable with using the meter (it's his), so he just needs to learn how to poke the cat.

Oberon is definitely feeling better. Appetite is very strong (I didn't even give the last dose of Cerenia and Mirataz because he was constantly demanding food). Weight is down a tiny bit from last week (from 11.7 to 11.5), but my bathroom scale isn't all that accurate so take that with a grain of salt. I'll continue to check BG this weekend and then check in with my vet on Monday to see where we want to go from here.

 

You are on your way! Yaaay

 

So glad testing is going well! Got are doing fantastic

 

Another update: We've only managed to get one pre-breakfast BG number so far (255 yesterday morning). All the other numbers have been right around 300, about 3 hours after breakfast. With those numbers, the vet is reluctant to start him on insulin just yet and would like me to try to get pre-meal BG 2-3x/week for the next 4 weeks, then check his fructosamine and urine glucose again. With luck maybe it'll turn out that this increase was just due to the pancreatitis and he's back to "normal." Not holding my breath, though. So that's the plan, though obviously I'll watch for any changes in appetite, behavior, etc.

 

Considering that he had a pancreatits flare it is true that his numbers may have been higher because of that but his numbers are not normal regardless because 300 3 hours after eating is high, if you could get a few more pre-meal tests ( maybe morning and night) that will certainly help but I wouldn't wait 4 weeks before starting insulin with a week you will probably have enough information to make a decision

 

Still holding pretty constant at around 300, even before meals, and his weight is down considerably from two weeks ago (11.7 to 10.7 lbs). Called the vet and I'm bringing him in on Monday to start insulin and do an initial blood glucose curve. I could probably do it at home but the vet wants him there just in case he goes hypoglycemic and needs attention.

 

Good the sooner he starts insulin the better, you will need to test more once he's on insulin specially since the vet is going to start him based on a curve made at the clinic, since cats usually give higher readings at the vet because of stress

Good luck and keep us posted on how everything goes

 

BG was 312 early this morning before breakfast. Then off to the vet where they did a pre-shot check, gave 1 U of Lantus, and checked once more sometime later. Values were 400 and 362 but the printout doesn't actually note times. Guessing the pre-shot BG was at about 9 am when I dropped him off, he got the Lantus at about 10 when the vet got in, and they rechecked at about 2 pm. (I'm assuming the higher value was pre-shot.) Definitely didn't show any signs of going hypoglycemic.

Current plan: 1 U every 12 hours for the next 7-10 days, then run a curve at home (pre-shot, then every 2 h for 12 h) and check in with the vet.

He didn't specifically tell me to check BG other than doing the curve in a week, but I'm thinking that I should at least be checking pre-shot daily to make sure he isn't starting off low.

[Board etiquette question: should I keep posting here or start a new thread on the Lantus board now that we're off and running?]

 

This would be correct.

where to post? It wouldnt hurt to post in Lantus. I would

 

No no signs of hypoclycemia all those results are high

That sounds like a good plan just take into consideration that you have to give insulin at the same time every day if the vet gave the insulin shoot at 10 am his next shoot would be 10 pm and tomorrow you have to give the shoots at the same time

You should never give insulin without testing first to make sure is safe to give insulin,since you are only starting and we do not know how he reacts if he's below 200 at the preshoot test do not shoot , hold the food and ask in the phorum for assistance as time progresses and you get more information the do not shoot number will go lower 150 or even less but for now

One more thing to consider is Lantus forms a depot and that depot is full more o less after 3 days ( it could be a bit different from one cat to another) and at that point his numbers may start to lower a bit don't be scared that is good as long as he doesn't go too low, remember the number to take action is 65

Here's some information regarding the lantus protocols
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

You can post here but if you start posting in the Lantus forum there will be a lot more of Lantus users that can help you

 

Preshoot this evening was 132 so I skipped the Lantus. Started a thread in the Lantus forum.