Without getting the pancreatitis under control, you will have a hard time getting his blood glucose values down. Pancreatitis causes severe pain, and that kind of stress will spike blood glucose values.
Pancreatitis control relies on symptomatic (anti-nausea medications like cerenia, pain relief medications like buprenorphine--though cerenia also helps some with pancreatic pain--, fluid therapy to replace fluids lost from vomiting or diarrhea, and appetite stimulant to encourage them to eat).
Cerenia has some anti-inflammatory properties that are just starting to be discovered, so it can be a really powerful medication for cats with pancreatitis who shouldn't be taking steroids. THAT SAID, cerenia on its own isn't always enough to get the pancreatitis under control. So if you have to keep him on prednisolone so the pancreatitis will be controlled, that's what needs to happen--what good is getting him off the steroid for his diabetes if he won't eat regularly?
Okay. Here we go. I've calmed down a bit so I can write now. This is complicated.
Until about a month ago or so, my first vet had him on 12 mgs of prednisilone, 8 mgs of cerenia, .2 ml of buprenorphine, 1 shot of B12. Chicken, no carbs at all, for diet. She told me the buprenorphine was not actually for pain, but it enhanced capillary blood flow in the pancreas. And his diarrhea kept getting worse. Pandemic hit..... Then came a $900 vet bill but no solutions and not much in the way of communication or instruction. Leaving me hanging. With a terrible case of diarrhea. She recommended chlorambucil. But she didn't give me any instructions on how to transition from prednisilone to chlorambucil anyway. I was reluctant to give it without instructions or coaching.
So I went back to a previous vet who does house call visits. Angie. She came over to the house. She wanted him off the pred (told me it causes diabetes), and off the buprenorphine (nothing in the literature indicates it increases capillary blood flow in the pancreas). So I started decreasing both. She coached me on giving chlorambucil 2 days a week.
Right around the time I switched vets, I took him off the chicken (he was showing signs of allergy to it, losing hair on back legs) and started him on pork. He began doing better. A friend did animal communication and he asked for beef hearts, so I got that and he gobbled it. That seemed to have a good effect, too. He told her he hated the buprenorphine, said it hurt his mouth every time (oral squirt). He always hated getting that one.
Started the chlorambucil 2 days a week. Doing okay, but still diarrhea. House call vet said increase to 3 times a week. Then the stools turned black and were horrible runny diarrhea. She said to stop chlorambucil.
On one particularly bad morning for Squeaky, I didn't have the heart to give him the buprenorphine (which I had been slowly reducing), so I just stopped. I also stopped giving him the cerenia and I had been decreasing the pred, and stopped that too. (Kept giving the weekly B12 shots and still am.) For a few days. Wow he seemed better. Then he started diarrhea again, so I started giving him 2.5 mg of pred each day. That helped.
All along, he would have up days and down days. Diarrhea, then a bit better then back again. Nobody could get the diarrhea stopped, this has been going on for about 3 years. All along, this last several months, he kept drinking more and more water. So finally Angie said, take him to an affiliated clinic for diabetes test. It was positive. That was about 10 days ago. And here we are.
Angie wanted me to reduce the prednisilone to 2.5 mg every other day. The first off day, he had vomiting and diarrhea. The second off day, vomiting. So I increased him back to 1.25 on the "off" day. He was dragging. Finally this morning he had 2 poops, out of box, mostly solidish but soft. Better than diarrhea. He's still dragging today. I increased his steroid again to 2.5 every other day. I've asked Angie about switching from Prednisilone to Budesonide as one person on this board has suggested. Have not had an answer from her. I have to ask the tech, she asked Angie, responded without a reply, I asked again. Takes a long time to get answers.
So I have some mirtzapine (which says expired 30 days after January 13), some buprenorphine (which he hates), an IV (I need to look at expiration date).
He switched to beef, that's about all he will eat now. Eating sporadically. Won't eat treats any more.
So after those two soft/solid poops this morning, he looked like he felt better. Today he's been eating a little here and there (when I hand feed him, he doesn't go to the dish).
He was, for the longest time, eating the pills ground up in his food. But now his eating habits are so irregular, mostly he is eating pieces of meat. So I have to pill him, which he hates. Mostly today he's been hiding and he's definitely avoiding me. Now he even dislikes our routine of playing, then massage, then inhaler.... because he knows the ear prick follows (regardless of how much love and petting he gets). He tolerates but is not fond of the insulin and will often run away from that too. We are not having a very good time. He is angry at me.
I'm not sure if he is nauseous (he will eat if he thinks the food smells good) or in pain. I do know that the high blood glucose levels are making him feel crummy. (Because the one time they went down to 97, he was so happy and looked so good and had some energy).
Mostly we have his asthma under control, but this morning he coughed a little bit at the blood glucose testing time.
There you have the story.
I'm doing the best I can. A bit confused about what to do next. Comments, suggestions, questions?
Thanks, Jan and Squeaky
