Treating diabetic cat with pancreatitis

[nepenthe]

My 12 yr old diabetic male seems to be having a fare-up of pancreatitis again. His SpecfPLI yesterday was 6.4. He is acting ok, not sitting in a meatloaf position. The vet thinks otherwise he looks ok. All of his bloodwork came back ok today. He doesn't seem to be eating like he did a year ago, but barely enough.

He had an attack and was hospitalized in Jan 2011. At that time his SpecfPLI was the same, at 6+, only at that time he had symptoms: dehydration, nausea, anorexia, and was sitting in that meatloaf position. He went home the next day on analgesics, anitemetics, sub-q fluids - all for a few weeks - and prednisolone. He's been on 5 mg eod of prednisolone ever since then.

At that time, he recovered pretty quickly. In one week, he regained a half a pound of bodyweight. In one month, he was running around the apartment and eating like a horse. 8 months later, his weight went from 13.7 to 14.1.

The vet has always suspected IBD but we've never confirmed that. His symptoms were always vomiting intermittently. Seemed to come in waves. he went on a canned-only diet ever since Feb 09, when he was diagnosed with diabetes.

Diabetes: was diagnosed in Feb 09, but went off insulin in 8 weeks and remained in remission until mid 2010. From then till his pancreatitis in Jan 2011, he had been tightly regulated with values in normal range on 1 unit of insulin b.i.d. Since his pancreatitis in 2011, his insulin requirements immediately doubled to 2 units b.i.d. And he has had poor glycemic response to his insulin - with values all over the map, some high and a few days later, some really low.

Lately there have been high flat unresponsive BG curves. This could be caused by either the 5mg prednisolone eod, or the fact that the pancreatitis could have been low and smoldering ever since Jan 2011 - affecting his insulin repsonse.

He has been losing weight since summer 2011. He was 14.1 lbs then and now is 12.95. Two months ago, he was 13.3, so he's been losing more lately. The vet thinks this is due to his poor blood sugar regulation as something is interfering with his response to his insulin - either the chronic pancreatitis or the prednisolone.

he is scheduled for an ultrasound on Thursday which should tell us more.

Has anyone else ever had a diabetic cat with chronic pancreatitis? And IBD?

Are there other drugs that can reduce inflammation in the pancreas other than prednisolone?

 

[d0zivyhoo]

Re: diabetic cats and pancreatitis

I'm sorry your precious kitty is having problems.

Have you had an ultrasound done? It's not cheap, but it helped me understand what's going on with my kitty.

Sarah's fPL score is 27, and she's not vomiting or showing any signs of pain (and she has a voracious appetite - I have a heck of a time getting her to LOSE weight). The only reason I talked the vet into doing the test is because of some things I saw on her pevious bloodwork (she also has CKD, and I test her often). I too had to take her off dry food once she became diabetic (darn renal diet - high in carbs). I'm not saying your kitty is not suffering from pancreatitis, but maybe it's as you suspect that IBD is causing the issues?

One of the best things you can do for an IBD cat is feed a quality protein, grain-free wet food. I see that you have switched to canned, but is it grain-free? Also, IBD cats do very well on raw diets.

Definitely, prednisone is known to exacerbate diabetes, and yes, it could very well be prohibiting the insulin from doing its job. I am dealing with two vets right now, and both of them refused to prescribe it for the pacreatitis due to the diabetes.

Unfortunately, it takes a while to wean off of prednisone, so you won't be seeing instant results. But, maybe you can discuss with your vet trying a different food in the meantime. Also, I give my kitty Pepcid AC, 2.5 mg. 2x a day. That helps with the excess stomach acid.



DZ and Sarah

 

[nepenthe]

Re: diabetic cats and pancreatitis

Hi, he is getting an U/S tmrrw which I hope will tell us more, despite getting a positive test confirmation for pancreatitis with the fPL score of 6.4 on Tues. I am mostly worried about something else going on more sinister like lymphoma. I am betting it will, at the least, confirm IBD and pancreatitis.

He is getting 2.5mg Pepcid 2x a day and its helping with the eating. Aside from weight loss and drinking more than ever in the past week, he has no other symptoms.

The vet thinks that the pred is causing him to become insulin resistant and that this might even be causing the pancreatitis. In one sense this could be as he was given fPL tests in 09 and 10 and both times he tested positive for diabetes and had normal pancreatic function. Not saying that the diabetes caused the pancreatitis, but it definitely preceded it.

In Jan 2011 when he had the pancreatitis attack for the first time, he weighed 13.1, down from his usual 13.6. 7 Months later in Aug 2011 he was up to 14.1 - a gain of one pound in 8 mos. I doubt he had any pancreatitis in Aug 2011 as he gained lots of weight, ate like a horse and had tons of energy (typically with pancreatits we see the opposite: lethargy, anorexia and weight loss)

Despite that, during all that time, his BG numbers were high (he has been on 5mg prednisolone eod since jan 2011) even though he was gaining weight and seeming better than ever... so I am thinking (and hoping) that its the pred that's been making him have poor response to the insulin. I tend to think that the diabetes somehow aggravates the pancreas and causes inflammation in some cats.

As soon as he was diagnosed with diabetes in March 09, I gave him canned only without any grains. Typically Fancy Feast Salmon and Classic Chicken. Tried all sorts of so-called "novel" proteins, like high end canned duck, but that along with Turkey wound up all over the carpets everytime I tried it.

If all goes well with tmrrw's U/S I will lobby her to take him off the pred and switch him to another diet and focus more on the IBD.

 

[Sandy and Brie]

Re: diabetic cats and pancreatitis

My non diabetic kitty Vandow has chronic pancreatitis with many acute flare ups. He had an ultrasound that confirmed it in 2010. SpecfPLI I think was high normal. Prior to the US his appetite was off for a few weeks and he was losing weight. He had occasional vomiting but that wasn't really an issue. He crashed a few days after his US and was hospitalized. He never has really bounced back from his first attack. A year later his US showed IBD as well. I haven't had an US done this year yet. He's on pred EOD, zofran, pepcid and atenolol for his heart. He get occasional fluids, sometimes cerenia, sometimes buprenex and lately he's been getting flagyl as well. His disease has been a challange to manage. I'm very lucky he hasn't had any problems with the pred. I'm thinking getting the pred EOD could cause sugars to be erratic. Have you noticed any trend in his sugars with his pred days and non pred days? A vet tech at my vets office has a younger kitty with severe IBD confirmed by biopsies. She went to an internal specialist and her cat is on leukeran. Her cat does not have cancer. The leukeran is helping her kitty too. I haven't done any research on that either. My diabetic kitty Brie has cancer and is on pred every day now. He was doing well on lantus 1 unit twice a day for four years. Now he's a work in progress. The last few days he's been getting 3 units twice a day. I just don't like such a high dose. Luckily he eats well and has a very regular feeding schedule. Does your kitty eat the same amount and same food every day and get his insulin at the same time everyday? You said that he eats but barely enough? Hopefully the US will give you some answers tomorrow.

Sandy

 

[nepenthe]

Re: diabetic cats and pancreatitis

He eats but some days its not much at all. For eg, yesterday he barely ate anything. I gave him pepcid last night and this am and tonight he has lots of energy running around all over the apt, and is eating fairly well, showing demonstrable interest in his food.

I've thought about looking at a detectable pattern between when and what days he gets his pred (5mg EOD) and when he has high BG readings. So far there are no correlations from what I can see.

The biggest question I have right now is: how could it be that a cat who is getting 5mg prednisolone regularly, every other day, can be showing clinical signs of pancreatitis with a fPL reading of 6.4?

The worry here is that something else is causing the pancreatitis, ie, neoplasia (the thing we all fear b/c so many IBD/chronic pancreatitis and diabetic cats come down with lymphoma)

The vet seems to wonder if the pred is what's making the BG readings high, and this is what is irritating the pancreas too. But she said she will look as deep into it as she can, to rule out things she mentioned like Cushing's disease, adrenal tumors, etc. I will ask if she can biopsy what she can.

In your case, I don't doubt that its the pred that's caused his insulin requirements to triple. I see this with mine and worse, there are times where he doesn't respond at all, like classic insulin resistance. And the top two causes: 1) corticosteroids and 2) pancreatitis - he has both.

 

[Blue]

Re: diabetic cats and pancreatitis

Because the fPLI test is just a snap shot of pancreatitis test, once you know how your cat acts during flares, there's no real purpose in doing the test. What you can do is treat to prevent flares, or to clear out flares.

One of my cats frequently tested in the grey area, so giving pepcid, and fluids, and keeping bupe on hand for pain is what you can do regularly. He was not a big water drinker, so water was always added to his food, and no harm to give pepcid to settle his stomach.

My other cat had frequent flares with fPLI numbers in the teens and higher, and she had the classic signs of meatloafing, growling, and tender sides with no appetite. Because of her extreme discomforts, and fluids plus bupe needed to settle her for a couple days, the vet suggested to give her B12 shots weekly to bring down the pancreas inflammation. It worked. She had no more flares after I starting her on weekly B12 shots dose 25u. I was also able to stop giving her pepcid every day, and used pepcid ver seldom, in mornings if I saw her doing her lip licking, likely due to her empty stomache.

You may want to change your Subject to include IBD, asking help to treat diabetic cat with IBD and pancreatitis. You should get some good advice from others with the same issues in their cats.

 

[nepenthe]

Re: diabetic cats and pancreatitis

There was someone alluding to what I am talking about in an archived thread from yrs ago. A diabetic on pred. Their owner wondered the same thing:

I still think that her being as high as she was for so long triggerred the pancreatitis even though pancreatitis is supposed to be the cause of the insulin resistence. When they sit at a high # for days and days it has to be weakening their system in ways that may not be visible by looking at them.

What I am thinking: the pred is causing higher numbers, which promotes insulin resistance and aggravates the pancreatitis, which itself also ends up promoting more insulin resistance.