Hey y'all! Thankfully, I haven't had to post in this MB for a while. My kitty's BG and insulin values are checked daily and she has been doing very well, and I'm getting her fructosamine checked soon! Yesterday morning, I think I accidentally gave her some of her insulin IM instead of SC, and her BG dropped (52) before dinner and she vomited a lot overnight (~9 times). Of course, this worried me, so I immediately called her vet and brought her in as soon as they could see me, which was 2pm. Brought her in, did full blood work, and everything was perfectly in range. Her liver, kidney, blood sugar, etc were all good, which rules out DKA (also, she's had 3 before and I know what that looks like for her). Her temperature, lymph nodes, and heartrate were good, and the only issue seemed to be dehydration (which is understandable, considering she threw up about 12 times before going to the vet). Vet prescribed Mirtazapine for the nausea, and she had it with her dinner. She just had dinner about 3-4 hours ago, and kept it down very well, until just now. She just threw up an excessive amount of water, with very little food mixed in. Seems like she was able to hold the food down, but a little bit came up with an excessive amount of water. She was looking better this morning but seems to be a bit frail from the loss of water now. After coming home from the vet at 3 she spent a lot of the time sleeping, which I expected since throwing up and traveling to the vet can be very taxing. Her BG is still within range, PMPS ~200 and she got a little bit less insulin with dinner, since she seems to be a little bit more insulin sensitive now. Earlier today, she seemed totally fine temperament-wise, but I think the vomiting is getting to her more, as she seems a little bit more sickly. Better written schedule of vomiting, food, and treat amounts for yesterday and today. For reference, her meals have water added to make the texture softer and so she is adequately hydrated. This is not new and has been her diet for about 6 months with no issue. Also, none of the throw-up has blood in it. [BG] Yesterday morning- 8:45am AMPS [110] 1.5units (lowest amount that I currently give her) 1/2 can Friskies Pate + water Finished all of her food, seemed fine Yesterday night- At 6pm (2hrs before dinner), she swiped at my roommate which made me think she was low. Tested her at 6pm [58] - 1 Cat squeeze treat. 7:45pm PMPS [112] 1.5 units Dinner time, 1/2 can Friskies Pate + water Finished all of her food. 12:30am- threw up a mix of food and water, mostly water. [52] - 2 cat squeeze treats and some dry treats. 4:00am- threw up again. [119] - Honey on gums by 5:00am- [216] This morning- 9:16am AMPS [408] ~1.9 units 1/2 can Friskies Pate + water Only ate about 2/3 of the food, seemed energetic though. 1:50pm- [184] Threw up again at around 1pm, but was busy calling vet so didn't get BG till 1:50p. still mostly water with a little bit of food in it. Vet visit 2-3pm This night- 7:00pm PMPS [202] 1.5 units (gave dinner early because she was running on a mostly empty stomach) 1/2 can Friskies Pate + water Ate about 90% of food, took Mirtazapine with dinner, started drooling. Food was given in intervals to avoid more vomiting. I noticed she was drinking water, which was good. She might have just drunk too much which caused her to throw up, but I was trying to also monitor her water consumption. 10:45pm- [231] 11:10pm- threw up again, a LOT of water. Like a full cup of water. 12:00am- [254] To be fair, seems like she's keeping food + water down in a longer interval at least, but I'm concerned she's continuing to throw up at all. TLDR: I'm concerned about the constant vomiting, but I'm not sure what else can be done, since we got a full panel of bloodwork and legitimately everything was in range. The only thing I can imagine right now is pancreatitis, but I figured that would show up somewhere on the blood tests as well. Any advice? Anyone dealt with something similar?
Hi and I am sorry about poor Ginger. Mirtazapine is not drug to control nausea. It is an appetite stimulant. I use it on my own Ginger about every other day to increase her appetite. Perhaps you meant Cerenia, which is an anti-emetic drug to control vomiting and it works rather well if given at the correct dose. Zofran is the best drig for nausea, but it sounds like you are dealing with vomiting and beyond that we don’t know. I definitely would not give her Mirtazapine as it’s just going to make her jumpy and meowy and possibly even aggressive if she gets it daily. More in next post…
Since her spreadsheet isn’t up to date for all of 2024 (I can’t see any tests on there) I can’t say much about her dose(s). But from some of the things you have written I can see that her blood glucose isn’t being managed properly. A cat should not be given honey on their gums when BG is 119. 119 is a perfectly normal healthy number for a cat. That shot her up to 216 and then, what would have happened is that she would drop back down after the honey wears off (it doesn’t last long.) also I see she gets squeeze treats and dry when she’s at 52? That’s not necessary either. 52 again is a healthy number for a cat. A 52 means to feed a small amount of low carb wet food and test again in 30 minutes if you are not used to seeing those numbers in your cat — usually a little LC is all it takes to help them surf in green numbers (50-99) and those are the pancreas healing numbers where you want them to be. I hope that you will read the “ProZinc Dosing Methods” sticky note at the top of this ProZinc forum. It goes into great detail about managing BG and dosing.
A regular blood panel (CBC and chemistry) would not show pancreatitis. For that, you need a special test run. The SNAP fPL is a test that can be run quickly at your vets office (did you take her to UGA?) it’s advisable to send blood to the lab for the SPEC fPL test if the SNAP fPL indicates pancreatitis.
I have a good paper describing these two tests if you’re interested. We also have a Primer on Pancreatitis that may be helpful to you. https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/
I really hope Ginger will be better soon! It’s strange you wrote last night. Just this week I was checking this ProZinc forum for cats who had disappeared on me. I looked at Ginger’s old thread. I was hoping she was okay. That vomiting will really take it out of her. Normally, vets will start cats who are vomiting badly with a Cerenia injection (bypassing the GI tract altogether so there’s no risk of vomiting up a pill.) That shot will be effective for about 24 hours. Vets usually send their clients home with oral Cerenia (Maropitant) tablets for subsequent days- one dose per day and dosing milligrams can vary as there is a wide margin of safety Cerenia tablets are extremely bitter and will cause foaming at the mouth and drooling if the cat gets a taste of it. I always put my Cerenia tablets into a number 4 or 5 size gelatin capsule so that there’s no chance of their mouth coming into contact with the medication. If she is continuing to vomit, I would go back and ask for the pancreatitis tests and most definitely would get them to give her a Cerenia injection.
Great guesses/info! Called her vet again and went back in, got an injection of Cerenia and B12, which was not initially our plan. She seemed to be better on the drive home, and vet said if she throws up today after Cerenia injection, take her immediately to UGA. Overall, her vomiting seems to be better, but she also isn't eating. I also supplemented an additional .5 units when we got home, because she was staying at 350. He also gave some gabapentin to have with dinner. Thank you for your messages and kind words! I wish I could say she was doing better 100%, but she was doing great before this post. 100-200 bg daily, great activity and very talkative and happy. This situation is abnormal for her, and her prozinc dosages seemed to be working well. Hoping she returns to that soon! Thanks again
I’m glad to bear she is talkative and happy most times. Hopefully the Cerenia and B-12 do the trick. The Cerenia injection will last for about 24 hours. I’m surprised she didn’t get some sub-q fluids to help with dehydration from the vomiting. I’ve seen that perks up a lot of cats (although I have the stuff here to do them at home fortunately). Hopefully, as she is able to keep her food/water down she will start to get back to her normal happy self.
If she doesn’t perk up then I hope the UGA vets will check her for pancreatitis. I have had very good care for my cats there. I would hesitate to give supplemental (an extra shot) insulin if she isn’t eating. Her BG could drop too low without any food on board.
I hope so too! For the dehydration, they checked for it and she didn't seem excessively dehydrated. She drank and kept down a decent bit of water today, which is good. As for the extra insulin, I'm worried if it's pancreatitis, it'll develop into a DKA if her BG isn't perfectly regulated. Time will tell, I suppose. Thank you for your concern and spot-on advice! I will definitely keep you updated.
We didn't, but since her liver and kidney values were good in her blood work, my vet said he doesn't think that's the case. Her BG has been very good this past week as well, so I doubt it too. I have some strips I will test as soon as I catch her using the litter
Did they check her electrolytes like sodium, potassium, chloride, calcium, magnesium, phosphate, bicarb. I hope those were all okay. If so, I feel better about everything. Do let me know if she starts eating again. I’m worried about lack of appetite. I will feel better when you tell me she is eating! Doss she seem to have any abdominal discomfort… like maybe when you pick her up? You could try some very simple food like plain meat baby food for a day or so to encourage her to eat. Just make sure it’s plain meat with no onions or garlic. Gerber or Beech Nut turkey, chicken or ham are good. Of course cats love the ham. I save that for a cat who really will not eat. You don’t want to let her go too long without eating because of the risk of hepatic lipidosis.
She’s still low appetite, but I gave her a kitty gogurt which seemed to wake her up a bit. I’m getting really nervous for her too. I’m not sure if the blood test included electrolytes, since I’m not sure what all of the acronyms are for that test. I’m just hoping she’ll recover soon.
It’s good to hear that she seems better. She needs to eat though. What is the Gabapentin for? Did the vet think she’s in pain? Gabapentin is for two things: (1) pain - although it’s definitely not the best drug for this because it’s for neuropathic pain - Buprenorphine is best for cats for pain and is also kidney friendly, but many vets these days are too lazy to do all the paperwork to provide Bupe to their clients because it is a controlled opioid….. (2) Gabapentin is given to calm a fractious cat before a vet visit. If she won’t eat food with the Gaba in it then don’t put it in. Right now it’s paramount that she eat, as you know. I’ve never given it in food before but only as a liquid (this is the form I got from UGA) or as capsules, or compounded into very small pills by a compounding pharmacy (those are low dose 50 mg. tabs.)
You and I have the exact same thought process! I tried feeding the gaba + food to her and she could tell it was in there and didn't eat, so I threw it out and put her normal breakfast out. She ate more of that, but still is taking her time. I think the gaba was prescribed for the alleged pancreatitis, since it can be painful from what I've seen. I also usually prefer the gaba suspended (I give it to her before driving back to ATL, since the ride can be stressful), but I'm out and the vet I go to does not have gaba suspended, only capsules and tablets.
