New to ProZinc and diabetes and pancreatitis

[Rocky&ClaireCat]

Hi everyone, someone in a facebook group for cats with multiple medical conditions recommended that I join this forum. Rocky is 10 yr, 5 months, and last week, suddenly became very ill on Wednesday with vomiting and lethargy. At the emergency vet, he had high WBC, very high glucose (318) and many other things. They gave him cerenia, famotidine, bup, and 100mL of fluids SubQ. They said to follow up with regular vet on Thursday or Friday. We talked with the vet on Thursday and saw her Friday morning. He was not good, so she said he had to be admitted, so I went back to emergency and checked him in for the afternoon and overnight. They also did an ultrasound, and it showed extreme inflammation. The vet said the duodenum showed about 5 layers of thickening. He said the mesentery looked 'mottled,' which is usually consistent with lymphoma. So then they did an aspirate biopsy, which he thought was lymphoma when he looked there under the microscope, but the pathology report came back the next day and it was not lymphoma, but consistent with chronic inflammation from IBD. They had him on IV, meds, etc, while he was in the hospital and he was doing well. The hospital vet spoke w/ my vet and they decided to start him on ProZinc, 1 unit, after each meal. They recommended using a diabetic food, and sent home two cans with him. He refused to eat either one and was generally refusing ALL food. I was feeding him water and food with a syringe all weekend. On Monday morning, he seemed a bit better, but then got much worse by afternoon and his 3rd eyelids were prominent in both eyes. I took him to the vet. His BG was high (380 something?) and he needed pain meds and fluids. They showed me how to do the SubQ fluids at home and sent us home with a bag of fluids, needles, etc. They gave him a 72-hour long-acting bupenephrine shot, as well. He's still on cerenia 16 mg once a day and pepcid 5mg once a day (morning). I also started CBD oil twice a day on Monday and the vet asked me to re-start his prenisolone 5mg once a day (night). His diagnosis right now is acute pancreatitis. The diabetes may or may not be permanent. They just aren't sure, since all of his labs had been fine up until last week. I ordered an AlphaTrak2 meter for him and it arrived yesterday, so I first used it at 430pm on Tuesday. His BG was 195 at 440pm and was 315 after he ate at 7pm. This morning, it was 268 before he ate. The vet told me yesterday NOT to give the proZinc 1 unit if his BG was below 300 before he ate. I haven't done a graph or nadir or anything on him, since this is all totally new. Where do I begin? What's next for this poor cat? He's feeling way better, though, by the way, and finally has an appetite back and is eating on his own. Additionally, he is pooping normally now (since Sunday), and the issue that initially led up to all of this is that he has had diarrhea and loose stool since I adopted him in Jan. of 2017 and he has had every test possible since then and everything was always perfect in spite of that. The diarrhea was worsening in May and June and I insisted that we do SOMETHING, so the vet started the prednisolone. He was great on it for the first 2.5 weeks, but then got sooo sick last Wednesday with all the vomiting, lethargy, excessive thirst, peeing all the time, etc. His history is that he was born on 3/1/08 to a lady who had LOTs of cats. In fact, when she died in Dec. 2016, there were 16 cats and a dog that had to be taken to the shelter. I went to the shelter in mid-January and he walked up to me and sat on my foot. He chose me. (He even jumped into the carriers I brought to the shelter the day I picked him up! I had set it on the counter while talking to the staff members, and he jumped up on the counter and crawled in!)

 

[Rachel]

Hello and welcome to our forum! We’re a smaller group which is why it took a bit to get back to you. We’re more active morning and evening though we try to check in between times.

First off, I’m so glad to hear Rocky is feeling better! Poor thing he’s been through it lately and so have you! So now that he’s eating again what is he eating? You don’t need that diabetic food...it’s actually not good for them. You want to feed a low carb wet food (under 10% carbs). A lot of people use friskies pate or fancy feast pate.

Second I am so glad you are testing! That’s one of the biggest hurdles and you’ve already got it! It’s good that your vet gave a no shoot number but it is way too high. We generally recommend not shooting under about 220 on the pet meter. At 300 he has around 200 points to drop before it gets to a low zone and that’s a lot.

The prednisone is probably what caused the diabetes. We get a lot of steroid induced kitties here. And that’s fine! You gotta do what you gotta do. I don’t know enough about IBD to help but I know steroids do help so uf you need to use them we can help you dose around it. The CBD should definitely help as it’s good for inflammation and appetite.

I know it’s scary and with everything else it starts to feel overwhelming but you’re not alone! We’re here to help and we really can. His numbers do far really aren’t bad at all and I believe with insulin on board he’ll feel even better.

What questions do you have for us? We’re happy to answer anything you need!

 

[Rocky&ClaireCat]

Thank you so much for the reply! I just spoke with the vet again and she said again to not give insulin if he's below 300 because she thinks the numbers are from the stress of the pancreatitis. She also said to test him only before meals so his ears don't get too sensitive. I am monitoring him for pain levels as his bup wears off tomorrow and they will give me pre-loaded syringes for the bup to give him at home so he doesn't have to go 'in' to the vet tmrw. Right now, he's eating FF chicken pate, since that's what he was eating a bit before (along with a dry food before, too). My biggest questions are about the insulin and the numbers, but the vet insists on not giving it below 300 for now, since he has such severe pancreatitis. She said cats can hang out in the 200's for a while, but if it goes too low, he could have seizures or die. (He also has heart issues, apparently, that were just discovered last week... heart 'gallop?'). I am feeling better about all of this today. This forum and FB groups have been very helpful. The info at the top is amazing! It's overwhelming having a 'suddenly sick' cat that wasn't really sick before.

 

[JanetNJ]

I agree 300 is high for a no shoot. Maybe do 0.5 200-300 and 1 above if you are nervous. Your vet is probably being extra cautious because he's not eating in his own much yet. Under 300 he still needs some insulin support though. Normal on a pet meter is 68-150. Test then feed then shoot, then try to get at least 1 more mid cycle number. It won't hurt his ears as long as you poke the edge and not the vein. Poor kitty I hope he feels better soon. You are doing a wonderful job with him.

 

[Rachel]

I can understand what your vet is saying. The higher numbers probably ARE due to the pancreatitis some, but I'm unsure why your vet thinks that means you shouldn't treat. That's like saying the reason you have a cough is because you have a sinus infection, so I won't give you cough syrup since there's a reason for it (not the greatest example but you get it). I mean, most of the cats here have gone diabetic for a reason be it food, genetics, steroids, or something else. We still treat them in hopes that we can get them OFF insulin...but we give it to them even after we've removed whatever reason they might have for being diabetic. Part of this is because to get them in remission, the pancreas needs a break. If we can give insulin to allow the pancreas to rest and recover, which they do better at lower numbers, there's a better chance they'll be able to come off the juice and be in long term remission.

Honestly, I DO get your concern about him going hypo. But my concern is different...I'm worried about DKA (diabetic ketoacidosis). This is a very serious disease that diabetic kitties can get...it's has a pretty fast onset and can be fatal. Now I am NOT trying to scare you at all, I just have to voice this concern. DKA is often brought on my an infection (which you have), too little insulin (which you have), and not eating (which you've had and could have again). It can happen even without these things, but with them, it's a lot more likely. I've been on this board since 2013 and I've never once seen a cat die of hypo, but I've seen several die from DKA.

So with that said, I want to reiterate I do NOT want to scare you. I'm not saying Rocky is going to get it or anything, but I have to voice that because I just can't stand it if I don't. I would like to ask you to read up on DKA (we have a sticky HERE with good info) and maybe ask the vet about it. Also, please PLEASE get some ketone testing strips (you can get the ones for humans from any pharmacy) and test Rocky frequently. It involves sticking the strip in some fresh urine, but we have ways to help you capture that if you need. I'd test him as often as possible while he's not getting insulin...at least once every other day probably. The earlier you catch this, the better.

I'm sorry. I know this post sounds scary and probably DOESN'T actually make you feel better like above, but I have to say it. I promise, I don't want to scare you. I just don't want to lessen the seriousness of this either.

I know it's hard to trust a bunch of crazy cat ladies on the internet over your vet. It's possible that Rocky will really be fine and won't have any problems. Testing for ketones will make ME feel better (not the main goal here obviously) and give YOU some good control so that you know he's fine or if something starts to develop, you can handle it.

Please please do ask any questions you have and don't let my post scare you off. I'm not saying you're a bad cat mom AT ALL. I know you're doing the best for your baby, but I wanted to be sure you knew about this. I think you're a great cat mom for all you're doing for Rocky and for all you've committed to keep doing for him.

 

[Djamila]

I wish I had more time to give an in-depth response here, but only have a half a second and I need to leave. I just want to echo what Rachel is saying. So just imagine that I wrote out a nice thoughtful response in agreement to her comments.

My kitty has pancreatitis too. It's absolutely the worst! It breaks my heart watching him be so sick when he's in a flare. I must disagree with your vet though. Yes, the BG is high because of the pancreatitis, but that means that your kitty needs more insulin, not skipped doses. That will just make the poor pancreas work even harder, while it's already sick! Whenever Sam gets a panc. flare, I increase his dose to counter the rise in BG. I do have to monitor because his food intake goes down, but if needed there is syringe feeding or we have a zillion tricks to entice kitties to eat something. That has never been a problem so far though. He just needs more insulin. It doesn't matter that it's the inflammation that is the cause of the BG rise. The point is that it's rising and we need to put the brakes on by giving sufficient insulin. Please don't' skip doses on those high numbers.

And please feel free to ask questions about what we're saying here. I know it's a lot all at once, and again I apologize for needing to be brief, but we are here to support you and do whatever we can to help build your expertise in all of this, and keep your kitty safe.

 

[Carol & Murphy (GA)]

Having been through several pancreatitis episodes, I agree with Rachel and Djamila on the need for insulin. here's hoping he'll be okay after the flare. Murphy needed steroids after his last flare. have you checked out ibdkitties.net? There's a ton of info there on pancreatitis and IBD

 

[Rocky&ClaireCat]

Thank you so much!!! I really appreciate the responses. It seems that his pancreatitis has gotten better. At least we are rounding the corner. He's his normal self today (and yesterday!) I emailed a huge list of questions to the vet yesterday and she replied and also asked Rocky to be seen by an internist this coming week. I called a major vet hospital (with an amazing reputation) and he got an appt for MONDAY at 9am! Lucky him. It's usually a 3-week wait to be seen there. I have been giving the 1 unit of insulin with each meal in spite of the vet's advice not to give it if his BG was below 300. His morning BG has ranged from 190-ish up to about 210 every morning. Evening before supper has always been in the 300's and mostly the upper 300's. He was not diabetic until this all happened, or at least all the diagnoses happened at the same moment last week. He had a fever and stopped eating and was vomiting and lethargic. BG was in the 300's at the hospital. That's how it all began on Aug. 1. He was totally fine on the last day of July (Or so he seemed.)