Newly Diagnosed with Co-occurring Pancreatitis and IBD

D

diane_schmidt

Member Since 2026
Hi wonderful community,

We're really struggling with our recently diagnosed kitty, Murphy--diagnosed 3 weeks ago. With co-occurring conditions, it's been tough to regulate her diabetes. We started her on 1 unit of Insulin Glargine-yfgn 2 x daily, put her on Royal Canin canned PD and PR (to support her IBD), have a continuous glucose monitor, plus supportive medications such as mirtazapine (which she receives once a day), Cerenia, when needed and pain meds, when needed. We free feed her because she lost weight and tends to eat small amounts because of her pancreatitis and IBD. Our vet just upped her dose to 2 units 2 x daily from 1. However, her nadir tends to be about 10 hours after her dose and often she doesn't come down very much if at all (we also use a ReliOn when her levels are too high for the CGM). However, the other night, she plummeted and very quickly at about the six hour mark, dropping from "HI" to below 120 within 30 mins. Since then, we can't seem to get her glucose to drop - she stays between 320 and well over 400 even with 2 units. We'll be seeing an internist, but that isn't for another two weeks (so hard to get in with one!).

Some questions for you:

1. I read about the Somogyi Effect and wonder if that's what's going on. I understand that it'll take a while for her to regulate because of the other two conditions, but has anyone experienced this effect?
2. Could it be the type of insulin she's on and should we try something else?
3. Or do we just give it time? I am worried about giving her two units at night and have reduced that to 1 because of her quick drop the other night. We're in touch with our vet, of course, but she looks at the report from the CGM and tells us she's still too high.

Any advice you can provide would be so helpful! We're just so worried about her and are not sure what to do.

Thank you, thank you!
Diane
 
Hello and welcome, from the west coast. First of all, there is some basic information we need, that you can put in your signature, such as date of diagnosis, type of meter being used, etc. Information here on what we want to see and how to display it: New? How You Can Help Us Help You! In that document is also information about the spreadsheet we use to record our cat's blood sugar levels, which is incredibly helpful for us to help you with dosing.

A couple things first. Three weeks is way too fast to expect regulation. Feline diabetes is a marathon, not a sprint. Our keys to helping regulation are a good insulin for cats, low carb food, and home monitoring. You are monitoring with that Libre, glargine is a great insulin for cats, but the food you are feeding is way too high in carbs for a diabetic cat. More to follow on that.

Somogyi in cats is very rare - it was an idea hatched out of a small non peer reviewed study based on humans, using fast acting insulins, about a century ago. More recent research (like 10 years ago), shows that using gentle long lasting insulins, like glargine/Lantus and Prozinc, starting on a lower dose, and increasing slowly with home monitoring, Somogyi doesn't happen. Having said that, I do remember seeing one new member whose vet had put her cat on 10 units to start!!!

What you could be seeing is what we call a bounce, definition here:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Click to expand...

Part of the key mentioned above is slower increases. Based on blood sugars seen, we increase by 0.25 or 0.5 units at a time. So as to not overshoot a good dose. Are you using syringes with half unit marking to give the insulin?

We dose glargine based on how low it takes the cat. When feeding a high carb diet - as you are - we don't want the going lower than 90. You did see under 120 (what number exactly?) so I would not increase the dose. And depending on how low she went, it's possible she needs her dose reduced. We also try to dose the same dose AM and PM. If you are having to reduce the dose every PM, it is probably better to just give her a lower dose both AM and PM. Lantus/glargine is a depot style insulin and here we find consistent dosing is best.

OK, about that food. I have had an IBD cat and I managed her IBD with novel protein foods and probiotics. She did eventually also need a low dose steroid. Visbiome is a good probiotic, along with a prebiotic like psyllium husk fiber. By novel protein I mean a diet of meats she hasn't seen before. Duck and rabbit are two good options and are what are in the PR and PD, but there are off the shelf commercial products with those meats that are low carb foods. Venison, lamb, pork, and kangaroo are other commonly given novel proteins, also with commercially available low carb options. What IBD symptoms does your cat see?
 
Wendy&Neko said:
Hello and welcome, from the west coast. First of all, there is some basic information we need, that you can put in your signature, such as date of diagnosis, type of meter being used, etc. Information here on what we want to see and how to display it: New? How You Can Help Us Help You! In that document is also information about the spreadsheet we use to record our cat's blood sugar levels, which is incredibly helpful for us to help you with dosing.

A couple things first. Three weeks is way too fast to expect regulation. Feline diabetes is a marathon, not a sprint. Our keys to helping regulation are a good insulin for cats, low carb food, and home monitoring. You are monitoring with that Libre, glargine is a great insulin for cats, but the food you are feeding is way too high in carbs for a diabetic cat. More to follow on that.

Somogyi in cats is very rare - it was an idea hatched out of a small non peer reviewed study based on humans, using fast acting insulins, about a century ago. More recent research (like 10 years ago), shows that using gentle long lasting insulins, like glargine/Lantus and Prozinc, starting on a lower dose, and increasing slowly with home monitoring, Somogyi doesn't happen. Having said that, I do remember seeing one new member whose vet had put her cat on 10 units to start!!!

What you could be seeing is what we call a bounce, definition here:


Part of the key mentioned above is slower increases. Based on blood sugars seen, we increase by 0.25 or 0.5 units at a time. So as to not overshoot a good dose. Are you using syringes with half unit marking to give the insulin?

We dose glargine based on how low it takes the cat. When feeding a high carb diet - as you are - we don't want the going lower than 90. You did see under 120 (what number exactly?) so I would not increase the dose. And depending on how low she went, it's possible she needs her dose reduced. We also try to dose the same dose AM and PM. If you are having to reduce the dose every PM, it is probably better to just give her a lower dose both AM and PM. Lantus/glargine is a depot style insulin and here we find consistent dosing is best.

OK, about that food. I have had an IBD cat and I managed her IBD with novel protein foods and probiotics. She did eventually also need a low dose steroid. Visbiome is a good probiotic, along with a prebiotic like psyllium husk fiber. By novel protein I mean a diet of meats she hasn't seen before. Duck and rabbit are two good options and are what are in the PR and PD, but there are off the shelf commercial products with those meats that are low carb foods. Venison, lamb, pork, and kangaroo are other commonly given novel proteins, also with commercially available low carb options. What IBD symptoms does your cat see?
Click to expand...
Thank you so much, Wendy! Incredibly helpful to know that this is a marathon and to not panic. In terms of her IBD, the only symptom she has right now is that she doesn't feel like eating, which could also be her pancreatitis or mostly likely both conditions. She was diagnosed with IBD because first, she was vomiting once every few weeks, then an ultrasound confirmed inflammation. Her pancreatic enzymes were also very elevated. We have experience with IBD kitties (we currently have one and have had them in the past), so I'm familiar with the novel protein foods, but we're finding it difficult to find a food that she'll eat. We've tried everything we can find. As with most IBD/pancreatitis kitties she'll eat a bit then not want that same food for the next few days, but she will consistently eat the PD and PR if we switch between them. Unfortunately, we can't buy kangaroo here in CA anymore. And we've tried brands like Lotus, Ziwi, Merrick, etc... with no luck (but we'll continue to try them). I think once her pancreatitis improves, her appetite will resume, but I know that can take a few months to resolve. We'll continue to try to get her off the canned PD/PR. But from my analysis, the canned version has about 5% carbs if feeding as is. Do you have a different calculation?

We also have her on mirtazapine, but that only goes so far in terms of her wanting to eat. We also give her sub-q fluids when needed.

Thanks, too, for the information about "bouncing". That definitely describes what we're seeing. I also appreciate your recommendation to keep her on a lower dose and slowly increase it by .25 or 0.5. We don't have the needles that have half units marked, and that would be really helpful. I'll ask our vet/pharmacist to supply them. The low we saw was 118. Today, she went down to 105. That's with a 1 unit dose yesterday evening and 2 unit dose this morning with her eating regularly. So we should move back to 1 unit 2 x daily do you think?

I'll download the spreadsheet and fill it in to share. Thank you, thank you! This forum is a lifesaver.
 
A little older food chart here says 15-16% carbs. For the duck, the first ingredient is peas (carbs), third ingredient is pea protein (more carbs), with some hydrolyzed soy protein (more carbs) thrown in for good measure.

Koha, Identity and Rawz are some sources of novel protein, so is freeze dried raw. For her appetite, you might want to ask the vet if you can get a prescription for ondansetron. I found it much better for nausea.

For dosing, once you get those have unit syringes, a 1.5 unit dose AM and PM might work. Will say more once I can see a couple weeks worth of data. For syringes, this Sticky Note on the Lantus forum has some brands and links. Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing. Some people order form ADW.

And some more reading for you: A Primer on Pancreatitis. Regarding the IBD, was a biopsy ever taken to confirm it was IBD?
 
Thanks, Wendy. The new PR and PD formulas list pea flour as the fourth ingredient, with the duck having water, then duck, duck liver, pea flour. The rabbit is: rabbit, water, rabbit liver and pea flour. So the carbs are much lower than the old formula. We tried the Rawz, Koha and Identity. She'll lick the Koha but doesn't want anything to do with the other two! She does like the Stella & Chewy freeze-dried rabbit, but won't eat it if we add too much water to it (to try to reduce the carb load). We tried other freeze-dried foods like Vital Essentials and she won't touch it (duck or rabbit).

Thanks for the recommendation of switching to ondansetron/Zofran. I didn't even know that was available for cats. I'll ask our vet. And with Zofran, I assume she wouldn't need Cerenia for nausea?

Her IBD has not been confirmed via scope because she hasn't been stable enough. Our vet suggested we treat it as IBD for now until she stabilizes and we can do a biopsy.

If you have other food recommendations, let me know. I feel like we've tried everything, but your list is a good reminder to keep returning to some of these as her appetite improves.

Finally, thanks for the primer and the links to the insulin care guide.

Wendy, you're a god-send. Thank you!
 
The PR and PD ingredients I checked on the Royal Canin website must still reflect the old formulas. Hounds & Gatos rabbit. was acceptable to my IBD girl for a while. Nature's Variety Instinct she liked for several years. Actually not the limited ingredient one which is medium carb, but the regular version that also had pork. She would eat Stella&Chewy's raw, but not freeze dried version, Primal freeze dried but not their frozen raw version. :banghead:

Regarding Zofran (generic ondansetron is cheaper) you can give it and Cerenia (or maropitant the generic). Or by itself. Cerenia is better for vomiting, if doing that. Ondansetron isn't "available for cats", you give the human version and get a script from the vet to get it at a human pharmacy.
 
Chewy sells odansetron in their pharmacy. You will need to provide the vet information so they can confirm the prescription. Most people give the odansetron pills but its also available as an injectable. If you need a liquid form, a compounding pharmacy like Wedgewood Pharmacy or a local compounding pharmacy would be able to do this.

My now GA diabetic had diabetes, IBD, pancreatitis, among other issues I had always fed him a commercial raw diet, switching to rabbit for the IBD.
 
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