Shaikha 4/26 AM & PM PS - HIGH

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wombat88

wombat88

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My work schedule is weird this week, so I had to adjust the times she is getting insulin so BG can be tested (tomorrow is another late work night, home late PM). She got insulin last night at +15.5 after the AM insulin. Her PMPS last night was 412, which wasn't bad considering she was at >600 AMPS and 384 at +4. No readings after that so I don't know how low she got, but I was surprised she didn't zoom up past 500 by the time I did her reading.

This morning as you can see she's already up to 588 at +10. If anyone is logged on, should I give insulin earlier than I planned? She's got another 1.5 hours to go (would be 1/2 hour early, but feeding at 9:30am my time seems unfair given that her brother has already eaten and she's wandering around crying for food). Or should I make her wait? One additional worry is that her poop today was a little soft. Will monitor that, but with rising BG levels and softer poop, that could mean she is getting another pancreatitis attack. No signs of pain yet, but will monitor. That is her pattern though -- rising BG, softer poops, and then BAM -- major problems. Am hoping she just got into her brother's food last night when my husband fed her.

Also, given how high she got this AM, should I stick with only 1 unit? I can do one interim reading this AM if I feed/shoot in another 1.5 hours, and possibly two readings if I feed/shoot now. I don't work late tonight, so I could do the PMPS earlier if need be or can stick with a full 12 hour schedule if that would be better. Tomorrow night will be my last late night, so I can get on a more normal schedule after this. I'll try to get another reading after dinner but that depends on when I can actually give insulin.

+10 588
AMPS = 478, gave 1U
+2 = 453
=9 = 443
PMPS = >600, gave 1.5U
+3 =
 
I would go ahead and shoot now so you can get a couple of tests in afterwards. As long as you've decided to start over a 1 unit you could stick with it today and test to see where it goes. If she stays high I would raise the dose back up.

Can you get ahead of the pancreatitis and head off an attack? I've never had to deal with it so I don't really know what the treatment is but maybe if she started getting the usual treatment now it wouldn't be a severe attack.
 
Rob & Harley said:
I would go ahead and shoot now so you can get a couple of tests in afterwards. As long as you've decided to start over a 1 unit you could stick with it today and test to see where it goes. If she stays high I would raise the dose back up.

Can you get ahead of the pancreatitis and head off an attack? I've never had to deal with it so I don't really know what the treatment is but maybe if she started getting the usual treatment now it wouldn't be a severe attack.
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I just tested again and gave insulin. The trouble is, she went from 588 at +10 to 478 at AMPS (+12). Something is going on here, because she did not get food or insulin in those two hours. Would a bounce due to overdosing insulin cause her BG levels to swing up and down? I did double check readings, so I'm sure of the numbers both times. Or could it be her pancreas producing insulin in unpredictable ways due to inflammation, which is what pancreatitis is?

One additional wrinkle in the mix is that up until 4/17, she had been taking two steroids -- prednisolone, which she has taken since last year, and budesonide, which is a very powerful steroid but one that is supposed to be more locally acting in the gut. The plan had been to try transitioning her to budesonide so that it would have less systemic effect and get her off the pred. Unfortunately, that wasn't possible. I ended up having to up her dose of pred to the normal levels (5 mg per day in her case) in addition to giving the budesonide. She then developed anemia, so we feared a GI bleed and decided to stop the budesonide as a result since it didn't seem to be working for her anyway. Her anemia has improved and we added sucralfate to address a bleed if in fact there is one.

Though budesonide works great for some cats who are diabetic (and thus reduces steroid-induced diabetes issues), it didn't work for her. I've heard anecdoctal reports though that for some cats it actually has triggered diabetes. The worry is that perhaps my experiment with budesonide has made matters worse for her and what we are seeing now is a reaction to that. Or it could just be pancreatitis rearing its ugly head again. It is hard to say, but a PLI test would let us know if she's actively having a flareup so that's probably what we'll need to do. I have to fast her for the test though, which isn't fun.

There isn't a way of heading off pancreatitis that I know of. I try to keep her BG levels as low as possible and stable to keep the load off an upset pancreas, but there really isn't any treatment other than taking care of symptoms when they occur. Some cats do better on lower fat diets, and if the cat has IBD as well (as Shaikha does), making sure you control that with food that agrees can also help keep flareups at bay. In Shaikha's case I found that giving salmon oil actually triggered acute attacks, so she doesn't get that anymore and she eats a novel protein diet that has no fish since that appears to be a trigger for her. They don't know enough about what causes the disease but a lot of cats that "ain't doing right" actually have it -- studies have even shown that many cats who are not symptomatic actually have the disease, so they think it is more common than people think.

She's not really been that well since late January. We had a terrible attack plus infection and high fever in early February, followed by gradual improvement and then a downtick in early April. She seemed to be doing better and stools got more formed, but her coat has gotten more poor over the past few weeks. It is hard to explain, but instead of being shiny and soft, it gets sort of dry and punk-looking when she's having a flareup. It could just be that we don't have the PZI dose right, but I think we have something else going on here.
 
Wish I could help, but I have no advice.

The 110 point drop is weird without food or insulin-- maybe someone can give you some insight.

Hopefully there is nothing else going on, but if so, it sounds like you are on top of it.

Good Luck!
 
UPDATE: I just had a long conversation with my vet and he looked over her numbers the past few weeks. He feels the drop from 2 to 1, while a good idea in theory, is probably too much of a change given the high numbers I'm getting. He'd like me to try a happy medium and maybe go with 1.5 for a few days to see how she's doing. If the numbers keep bouncing all over the place, he wants to do a PLI. He also talked about doing a fructosamine test, though I'm sure the results will be poor given how high her numbers have been.

I've already given 1U this AM, so will stick with that and will do BG tests at +2 and +4 before I leave for work. If she reads above 400 tonight then I'll increase her dose to 1.5U. Sound like a plan?
 
We have see our share of steroid induced diabetics here.

I think in general bg's can and do flucuate up and down some, excersize will bring down bg's, etc so was she romping around or anything.

I can't remember if you've tried a raw diet. I've heard that really helps with IBD etc. I've recently switched to raw and have seen a great improvement in the overall health of the whole gang. My vet urged the raw diet to give Harley a better chance at lower bg's. Right now I'm experimenting with the timing of snacks.

For a kitty with multiple serious health issues you would treat those first and the diabetes second, do what you need to for the pancreatitis and IBD and we can manage the diabetes around that.

If you have a strong gut feeling that something else is going on I would follow up on it. Our guts rarely let us down if we listen to them.

Robin
 
Rob & Harley said:
We have see our share of steroid induced diabetics here.

I think in general bg's can and do flucuate up and down some, excersize will bring down bg's, etc so was she romping around or anything.

I can't remember if you've tried a raw diet. I've heard that really helps with IBD etc. I've recently switched to raw and have seen a great improvement in the overall health of the whole gang. My vet urged the raw diet to give Harley a better chance at lower bg's. Right now I'm experimenting with the timing of snacks.

For a kitty with multiple serious health issues you would treat those first and the diabetes second, do what you need to for the pancreatitis and IBD and we can manage the diabetes around that.

If you have a strong gut feeling that something else is going on I would follow up on it. Our guts rarely let us down if we listen to them.

Robin
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Can't use a raw diet with her, as she is immune-compromised. She has extremely low white cell and platelet counts, always has (maybe congenital; haven't found a reason despite many tests in the ten years I've had her). No way I could risk a raw diet, especially since the pred further reduces the immune system. She isn't exercising, so I don't think romping is causing the changes.

That's primarily what we've done. We can't get her off steroids, so we just have to deal with the diabetes as a consequence of her treatment. I think I've got her on a decent food to manage the IBD and pancreatitis now. I think the use of the other steroid may have complicated matters, but my gut is saying we've got pancreatitis rearing its ugly head again. Will definitely follow through if the pudding poops continue or appetite tanks, as that will be confirmation.
 
You already have a frutosamine test, it's called your spreadsheet.

Good that you can get a +2 & +4, that will give you some insight into what the 1u is doing.

Was there anything in the Laura & Harley post that you havn't tried yet?

Sorry this may sound like a dumb question but why would the raw compromise her immune system? Because of the bacteria?
 
No time to do another test, unfortunately. She just left another puddle of poo on the floor with blood in it. Am rushing off to the vet now. He leaves early today, so I need to get there before then.

Raw food has bacteria in it, and her system is immune-compromised so she can't handle bacteria that other cats with normal systems would handle in stride.
 
Wendy....waiting to here how S is. Sorry you had to go to the vetty bean. (((((S and Wendy))))) sending sweet healing and loving light vibes your way.
 
I didn't take her to the vet, just the stool since I knew he had to leave early today. Tests showed definite blood in her stool, not a good sign. I will leave her at his place tomorrow during the day so he can do more extensive tests and a thorough exam. We went through the spreadsheet and he definitely wants me to increase her insulin to 1.5 units tonight. We'll stay at that level and see how she does, but of course we'll know a bit more tomorrow. More than likely either her IBD and/or pancreatitis is flaring up though. Dang! He did ask me to make some changes in her meds in the interim so I'll do that, but we'll know what other changes we need to make tomorrow. He would like to do a test for her pancreas, but is concerned about fasting with her BG going all over like it is. He wants to see how she does with the exam tomorrow and we'll make a decision then. If she's tender, we should test. Though all it really does is confirm that the pancreas is inflamed, tracking the numbers helps a little in knowing whether treatment is effective. We need to get the blood out of her stool because her last PCV was 21%, so she's anemic and blood loss is not what she needs right now. She needs those healing vibes, that's for sure.
 
sorry to hear this wendy....it amazes me how much you know and how well you have cared for you little girl.
she is so lucky to have such a wonderful mom.
feel better S....we are all pulling for you!
 
Thanks for keeping us informed, Wendy. I agree with the others, it's most impressive how much you know and all the bases you have covered in helping her. Sending many many good thoughts and vibes your way! cat_pet_icon
 
Just an update. I edited my original post, but am home now. Her reading at +2 was 453 and at +9 was 443. Don't know how low she got today, but I'd guess not too much. Will retest before PM meal but plan to shoot 1.5U as vet suggested. She seems quiet, but okay other than that. I was worried about her while at work today. I need to start weighing her regularly to ensure she's not losing weight as she feels lighter to me tonight. Vet will check ketones tomorrow when he does other tests. Thanks for your support today.
 
I agree with raising the dose,

I was worried about her today too. I'm glad the vet will be checking her out tomorrow.

((((Wendy))))

You're doing great, hang in there.

Robin
 
Thanks, because I think she needs them. She just had some more blood-tinged poops. :( She also feels warm to me. Not burning up like she was in February, but definitely not normal. I was going to take her temp but with the bloody poops I'm not sure I should put the thermometer in there. She'll be at the vet first thing tomorrow, that's for sure. She is mostly being quiet tonight. I don't think she feels that well. Will test her BG one more time before bed. Am hoping we can get it down below 400, which would be helpful. I also plan to give her some subQ fluid because I wasn't happy with how her hydration seemed earlier. Tomorrow will be two weeks exactly since we lost her brother to complications from renal failure and severe anemia. She's suffering enough missing him and doesn't need this too (and neither does mom, who isn't over her grief either). Am trying to stay positive. :sad:
 
Wendy I hope you too can just love on each other tonight. I know all will be ok...whatever happens...all will be ok.
 
Awwww. Remember it's not too uncommon for cats to get a little blood if they are straining (fresh looking blood, not the dried tarry type). Hopefully it's nothing too serious and the fluids & vet trip will help her out. Do they send you home with pain meds for the pancreatitis? If not, I would definitely ask for Buprenex, it's a miracle-drug IMO. There are some good threads somewhere on Pancreatitis that I think Jojo typed up at some point. I don't have the bookmarks, but there are plenty around on Health with pancreatitis problems too, so if you haven't posted there about it you might want to at some point.

So sorry about losing her brother. That is really tough. (((((((hugs))))))) :YMHUG: :YMHUG: :YMHUG:
 
Joanna & Bix (GA) said:
Awwww. Remember it's not too uncommon for cats to get a little blood if they are straining (fresh looking blood, not the dried tarry type). Hopefully it's nothing too serious and the fluids & vet trip will help her out. Do they send you home with pain meds for the pancreatitis? If not, I would definitely ask for Buprenex, it's a miracle-drug IMO. There are some good threads somewhere on Pancreatitis that I think Jojo typed up at some point. I don't have the bookmarks, but there are plenty around on Health with pancreatitis problems too, so if you haven't posted there about it you might want to at some point.

So sorry about losing her brother. That is really tough. (((((((hugs))))))) :YMHUG: :YMHUG: :YMHUG:
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She's not straining, but the blood is fresher looking in color. I had another cat long ago that ate a pound of butter (!) and had bloody diarrhea for weeks, so I'm hoping this is just irritation as it was in his case. Combined with her anemia though, it worries me. We'll check PCV again tomorrow and hopefully it is above 21% and not dropping.

We keep buprenex in the cupboard, because she's had so many flareups. When she first was diagnosed, she was on it for many weeks. It is a miracle drug for pain, I agree. She already takes ondansetron for nausea, zantac for acid, and prednisolone daily for her chronic pancreatitis. We toss in subQ fluids and buprenex, and sometimes antibiotics when flareups are bad and she's running fevers, and sometimes she has to go on IVs if it is really bad.

I'll check out the health forum to see if others have ideas we haven't come across on treatment. We've done the best we can, as I live in a rural area and my vet has a fairly simple practice. Internists and specialists are hundreds of miles away from here. There are ER type places an hour or so away, but not really staffed by specialists of any sort. He's a good vet though with a big heart, and what he doesn't know he works hard to find out. And of course I've also learned a ton about feline medicine too so we've made a pretty good team.

Thanks for the condolences. It has been a rough past few weeks around here.
 
Sorry I didn't post last night but I worked late and got home dead tired. Okay, here's an update:

My vet did a series of tests yesterday, another CBC, and a thorough exam. He thinks her problem is primarily IBD for now, since she isn't seeming tender in her abdomen like she was previously. That said, he agreed that even if obvious pancreatitis symptoms like pain aren't present now, given her history, they could pop up in a few more days even though she seems okay now, so I'm stocked up on buprenorphine. He felt around for masses, and said her abdomen seems clear. He feels there is inflammation in her lower colon that that is likely contributing to her anemia. Her anemia wasn't worse, but it isn't better, but he said there is regeneration, so that's a good thing. Her PCV remains around 21% -- still too low, but at least it isn't falling. Her stool this morning looked a little better, with less blood but still pasty-looking.

She was eating fine, but last night didn't want to finish her meal and we had the same problem this morning (got food into her with lots of coaxing), so we may also be dealing with a pancreas problem as well. Her white count was in the normal range, which is actually abnormal for her since she always runs low. We decided to put her on antibiotics again, a different one, since she can't fight infections on her own and he feels that one is present. We also increased her flagyl to the maximum dose for a few days, following a protocol that he got at an IBD symposium he attended recently. We'll back her off that after five days, but he thought she needed the extra help right now. I plan to monitor hydration and may give subQ fluids to see if that helps some. I gave her subQ fluids on Tuesday PM and Wednesday was a better day, so perhaps they helped.

My vet said it can be hard to disentangle the two sets of symptoms when cats have both diseases because they are so similar. We didn't run a spec fPL or PLI yesterday because we'd not fasted her. The good news is that her blood glucose levels have come down some, though this morning it was just under 600 again. Yesterday she stayed between 170 and 340 most of the day, before shooting up just before her AM meal today. She looked much better to me yesterday (of course, since she was going to the vet!), but this morning looked sicker again. The waxing and waning of symptoms leads me to think that her pancreas is also upset, in addition to the spikes in her blood glucose and now the poor appetite. Her past pattern has been fevers with the pancreatitis, so with the high white counts maybe that's the case or perhaps she's got some yucky stuff in her GI that is causing that.

We are going to try the antibiotics for a few days and see if she improves. If not, then we'll try to fast her and get a pancreatitis test done again, especially if her appetite continues to be poor. I probably will try switching her to canned food so I can assist feed, though she prefers kibble. That said, if her appetite is punky then she sometimes is more willing to nibble at the canned just because of the change and maybe it goes down easier. She vomited undigested food on Tuesday, so canned may be easier on her right now and would be better for her diabetes anyway. I do think she's nauseated, so if that continues I'll probably switch her to anzemet temporarily (she's on ondansetron now) and maybe even try a dose of buprenorphine to see if that makes a change in her appetite.

Times like these you wish you had x-ray vision so you could look inside and know what was the problem! Having a patient that could talk would also help. :)

Wendy
 
Just curious--I used Procrit ie. epogen when my Kitty became anemic. It helped with red blood cell production. I used this in a crf kitty, but it increased her RBC tremendously. I don't know if this is practical for what you are dealing with--but, I just wanted to mention it.

Good Luck.
 
Thanks for the idea, but Procrit or epogen only work if the anemia is nonregenerative. She is showing regeneration, so her kidneys are making the hormone necessary to make red blood cells, unlike cats with renal failure who usually can't make that because their kidneys are not functioning properly. The problem is that she is either losing blood in her gut and/or the red cells are being destroyed due to pure red cell aplasia (she had a rare reaction to leukeran last year and has been anemic ever since). It's complicated, unfortunately, but her entire case history is that way. We don't know why she has always had bone marrow suppression nor do we know why she's losing blood in her gut. My vet doesn't have an ultrasound and isn't equipped to do things like needle biopsies so in some ways we are working in the dark here.

I did just call him again and he's concerned about the spike in her glucose as well as appetite loss. He wants me to give subQ fluids tonight and to also try some buprenorphine to see if that perks up her appetite. If it does, that tells us she's in pain -- whether from an inflamed pancreas or possibly something new like colitis we don't know. If she's still off food tomorrow he wants me to bring her back in for more tests to include a PLI or spec fPL to check her pancreas. The problem with those tests is that they don't always indicate pancreatitis if it is chronic.

He wants me to do some more curves over the next few days to see if the variation in glucose levels is because of the change in insulin dose or possibly something else. My vet suspects it may be a combination of the two.
 
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