Up and down, round and round...

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Tinwhiskers

Tinwhiskers

Member Since 2020
Worst. Rollercoaster. Ever.

What we thought was a re-occurring bout of Cystitis and weight loss turns out to not only be a lovely UTI - but we also come to find out she has a very wicked pancreatic abscess!

Fast forward a few weeks later and the UTI is under control. Yay! But, it doesn't look like much progress has been made on the abscess. Her organ functions are good, however a test reveals her BG is elevated.

OK, we can monitor that. Get all the supplies, start getting used to what we should expect (glucose spikes last how long? Oh, a few hours is normal for an unregulated cat? Sorry ER, we're new to this monitoring thing) and get a feel for numbers...

... And THEN, an ACL tear.

Poor Leena has had a rough few months lately, and her readings are ranging from 12.7 (256) to 22.1 (445) - we simply can not figure out what is causing the wide range in spikes.

She is currently unregulated as they were trying to have us do home monitoring and see if her pancreas is producing enough insulin without needing injections, and it seems as if it COULD recover but it varies so much... we are unsure if part of the readings are increased pain/stress from the ACL tear.

We are thinking she needs some kind of regulation but are not sure what would work for her, and we can not have her undergo surgery for the ACL due to that and because she has lost too much weight to risk anesthetic.

Has anyone encountered ANYTHING similar? Can pain and recovery, along with diet regulation (she is on Purina Urinary management OTC for carbs & phos - plus other Purina flavors that fall within the same levels) cause such fluctuation in levels?
 
Poor Leena just can't catch a break, can she!

I can't comment on all the complications (there should be some more educated responses soon) but if her readings are that high it sounds like she needs insulin therapy. Was a fructosamine test done?

Illness and stress can and do increase blood sugar. Pancreatitis can knock a cat into insulin dependence. Purina UR (if that's the same food you're referring too) is still too high in carbs for diabetics, so that doesn't help. Is it wet or dry food?

@Wendy&Neko has experience with high blood sugar + cystitis food choices.

Wendy, not sure who might be good to tag for everything else? Seems like a mixed bag, poor thing!
 
@Panic It would be the Pro Plan Focus wet (blue and teal), the last charts I've seen from the catinfo.org page had those at safe levels but the UR at unsafe - plus she is a flavor diva and can't abide the same flavor for eternity :/

Our vet had her on Hills S/D prescription foods, wet she wouldn't eat and dry she would constantly throw up. We have tried other brands that had the same carb and phos levels as the Pro Plan Focus but she wouldn't eat those for long.

We currently have her isolated to the bedroom so the other cats can't accidentally hurt her. Did a reading on her about an hour ago at 9PM our time with a reading @ 17.6 (354). Her last feed was a few hours prior to that at 4pm by the hubby. When I got home we did a reading at 6:30 before her dose of pain medication and she was at 21.6 (435).

Saturday, the day of her vet visit for her leg, she had a reading of 268 that night even before we administered the painkillers she was prescribed.

We have started giving her some Milk Thistle and Turmeric to try and help ease her pancreatic pain and the inflammation in her knee, .5 ml twice a day. I am also looking in to adding MSM and B-12 Methylcobalamin for her joints.
 
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Gotcha, glad you're on top of that already. One less thing to worry about.

It certainly sounds like she needs some help getting those numbers lower. Hold on for more helpful replies; not sure where you're located but for most of us on the forum its nearing midnight so a lot of people may already be in bed tonight.
 
@Panic - No worries, midnight is not far off for me either so completely understand. What has me most worried has been her weight loss, her weigh-in at the vet this past weekend has her at 6.5 lbs (2.9kg) which she has been hovering around for about a month now.

She has her appetite back at least and is keeping the new food down even with the ACL tear, which is an improvement. We currently feed her as much as she can tolerate and leave food out for her when we go to work. She is on .2 ml of Buprenorphine twice a day.

The downside to the Pro Plan Urinary is the protein content, it just isn't that high for any of them so we have been adding in chicken shreds to try and boost her intake there. We just don't want her to go too long and risk running in to more issues than what she already has. We'd like to start getting her food needs met while figuring out what we need to do for insulin or other therapy.

Her primary vet is on the smaller side so we had to take her to another office that was able to do the ultrasounds to monitor her pancreas. They are overwhelmed and communication has not been the best, and I have been lurking here for a while prior since we were thinking of adopting a diabetic cat... well, ours decided to corner that possible market so here we are!
 
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I cant address these issues. I dont have the chops to do that but wanted to send my best thoughts and prayers for Leena and YOU! Diabetes is hard enough. Your dedication is admirable and I want you to know we are ALL rooting for you and extra sweet Leena. She is just too adorable for words. What I lack in education I make up with support!
Keep asking questions Theres a wealth of information here at your finger tips! USE US!
jeanne
 
Thanks @jt and trouble (GA) - the Cystitis has been an issue since she was a kitten so we are used to that and have a routine, it easy to manage. The pancreatic abscess has been very stressful though! Now an ACL tear on top of it?

Our vet and a specialist she consulted think she would do OK letting the knee scar over if we can get her glucose under control.
It is just all over the place with everything going on.
Her reading this morning, while she was eating her breakfast, was 19.5 (394). She was more active and actually pretty fussy about getting her reading. She had not taken her pain meds yet (and didn't enjoy getting them either), and we did leave food out for her overnight since her appetite has increased. Bowl was empty this morning and I could hear her eating off and on through the night.

Will definately try and be as active as possible so we can hopefully get her into a good place!
 
Hi Tinwhiskers,

I'm sorry to hear that Leena has been having such a rough time of it. I'm glad to hear her appetite is picking up.

My Saoirse had chronic pancreatitis, not quite the same as the abscess your little one has, I assume, but it did cause digestive upsets and appetite issues at times. Here's a link to a site that I found really useful. It helped me to learn how to spot the signs of nausea issues and also what treatments are available to help with both queasiness and poor appetite:

Nausea and Appetite Loss - Symptoms and Treatments

There's also this helpful post from the FDMB FAQs section:

Suggestions on Stimulating Appetite

Just to cover all bases, is Leena pooping OK? I ask because sometimes constipation can lead to vomiting, and buprenorphine can have a constipating effect. If you ever need any help on such issues, the following site is very helpful:

felineconstipation.org

Maybe you might find something in that lot to help your little one if her appetite gets iffy again.

Wishing Leena a speedy recovery.


Mogs
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@Critter Mom they prescribed low dose Cerenia for any nausea, which has helped when she first had issues keeping food down. Currently she has not had an episode of vomiting in about a month but we still have some medication on hand. Hoping when I can read through the links there will be some other ideas we can incorporate instead!

She is pooping but it is not daily, so I am likely going to add a bit of Miralax to her nightly feeding if that will not add to her current issues.
 
Awww. I'm glad she's eating better. Pancreas issues are the pits. :(

If her GI transit time is consistent and her poops are firmish/yielding but not hard (and yes, squeezing them is the only way to find out - joys of critter parenthood, eh :rolleyes:) there's probably not much to be gained from introducing a stool softener. She just needs to eat more fudz. (You listening to this, little Leena?!).

Another thought: has your vet checked Leena's B12 and folate levels (often the case where there are GI/malabsorption issues)? If the B12 is low a course of B12 injections can give a general boost to a kitty and may help a little with appetite (and also possibly with gut motility).

WRT Leena's blood glucose regulation, I'd be grateful if you could confirm that I'm correct in saying that Leena is NOT currently receiving any insulin? (I have anxiety-related cognitive issues and I'm struggling a fair bit today and I want to make sure I've understood your previous posts correctly. :) )

Also, can you tell us:

- if your vet ran a fructosamine test. If yes, when was it done and did it confirm that Leena's BG was above the normal range for a non-diabetic cat?

- exactly how long Leena's BG levels have been elevated (i.e. in the diabetic range).

- are you monitoring Leena's pee regularly for ketones? (<< This is really important if she's in consistently in diabetic BG numbers, not eating enough, not getting insulin, and there's infection in the mix).


Mogs
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@jt and trouble (GA) -

I think Leena's BG is being monitored at home so starting the spreadsheet now is a good idea from you, Jeanne. Tinwhiskers could just put 'No Dose' in the insulin columns for now. The record of the spot checks would form a valuable baseline. All data are good data! :cat:


Mogs
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I had the opposite problem somewhat when first I joined: Feline Health was a bit quieter than usual at the time. There were a few occasions where I ended up sat staring at my PC screen hammering the refresh button and whimpering to myself, "Pleeeze help meeeee!!!":oops:


Mogs
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No worries all, I was going to ask how to alter the SS since she isn't currently receiving insulin.

I think they checked her fructosamine levels when they did a full panel after her UTI resolved. Attaching the document from that test. I know they said she was not ketonic.

Just got off the phone with the office that has been doing her ultrasounds and we are going to figure out if she needs another followup for that, and doing her first curve at the same time. Tech needs to confer with the doc.

This whole ordeal started early May, and we have been trying to see what direction they want to take but have been having difficulty with consistent communication. Since they also have a 24hr ER unit everyone is feeling the strain.
But at this point, she absolutely needs insulin.
 

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Pffft, you all may be strangers but have a lot more experience with this than I do! I will try to answer anything I missed in more detail after work tonight.

But her stool is consistent and firm so she may just need more food.
I know two of the boys were being naughty pigs and cleaning her bowl out before we isolated her. But being semi-feral kittens before we adopted them (and starving), we know it's that fear of not knowing when they will see another meal.
 
Tinwhiskers said:
at this point, she absolutely needs insulin.
Click to expand...

I would be inclined to agree. The lack of sufficient insulin is also potentially a strong factor in Leena's being underweight (body can't utilise nutrients efficiently without sufficient insulin).

I see from the labs you posted that her BG was elevated (c. 300mg/dL/16.8 mmol/L, lab values) as far back as 14 April, although the spot reading for BG for a blood draw at the vets isn't the most reliable metric as it can be stress-influenced, hence the need for fructosamine testing to properly assess a potentially diabetic cat (gives an indication of the average BG level over the past couple of weeks, cat in its own normal environment). I can't see a fructosamine test on the lab report.

With regard to starting to enter data into a spreadsheet, do you have a rough idea what time each day you'd be likely to give insulin so that it will fit in with your own routine (e.g. 7am and 7pm)? Say for the sake of argument you choose a 7am/7pm schedule, then you could use the spreadsheet columns to record the data you're gathering at the moment as follows:-

Time of Test Column to use
----------------
7am AMPS (morning preshot test result for kitties on insulin)
8am AM+1
9am AM+2
10am AM+3
. .
. .
6pm AM+11
7pm PMPS (evening preshot test result for kitties on insulin)
8pm PM+1
9pm PM+2
10pm PM+3
.
.
(etc., etc.)


Mogs
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Tinwhiskers said:
... after work tonight.
Click to expand...


Important Precautionary Recommendation:

Bearing in mind Leena's current food, weight, pancreas status and BG levels, I would recommend you start checking her pee daily for ketones, just as a precaution until she's well established on insulin. Maybe you might be able to pick up some test strips (e.g. Keto-Diastix) while you're out.

Here's a handy link on collecting pee samples:

Tips to catch and test a urine sample

Thrill a minute round here. :woot:


Mogs
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Idnit' though?! We can definately to the keto strips, hopefully they work better than the glucose strips as those were way off when compared to any device reading.

For now I have been doing roughly three readings a day. Usually between 6-7am, 6-7pm, and 9-10pm.

Sorry, you are right and I wrote down the wrong month. That time has gone by so fast is a bit worrisome, especially with this issue. The first time we brought her in was to the ER for the UTI issues (blood in the urine, more frequent urination). We have been doing ultrasounds about every 2 weeks since then and it has gone by way faster than I thought. I will ask about the fructosamine check and see if that was actually done or just mentioned.

Hoping to hear back from the vet today and we can get a date filled in for everything she needs. Is there anything else we can do in the meantime to try and get her jumpy numbers more stable?
 
Urinalysis strips testing only gives you an indication of how much glucose has tipped into the urine over several hours. They're not a substitute for blood monitoring, although that's all some caregivers get as far as doing, largely because a lot of vets don't advocate anything else. Indeed, some vets insist that caregiver monitoring be restricted to monitoring of water consumption so that one doesn't "stress the animal out." (I can personally attest to this.)

Tinwhiskers said:
Is there anything else we can do in the meantime to try and get her jumpy numbers more stable?
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Not that I can think of right now. Other members may have some suggestions.

Tinwhiskers said:
Sorry, you are right and I wrote down the wrong month. That time has gone by so fast is a bit worrisome, especially with this issue.
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No need for apologies. :) It's very stressful when anything is wrong with our little ones, and trying to take in a mountain of new information on top of that is not easy. It's all I can do to string a coherent sentence together most of the time. :oops:

Be sure to let us know how you get on with the vet.


Mogs
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Oh, an idea for your baseline data gathering. Try grabbing a little 'mini curve' with spot checks as follows:

1. Withhold all food from Leena 2 hours prior to a scheduled mealtime (no snacks or treats either in this period). You do this so the next reading won't be food influenced.

2. Do a BG test just before feeding Leena.

3. Test Leena again about 2-3 hours after.

These readings should give you an idea of how much influence, if any, dietary carbs may have on Leena's BG levels. If you test again a couple of hours later it might throw some light on how her system is currently handling ingested carbs.


Mogs
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We could definitely do a mini curve this weekend. Right now with her weight so fragile we're just letting her eat what she likes during the week. So far she seems more alert today, even with her numbers staying the same. I am putting together the SS tonight.

Just added some MSM to her joint/inflammation booster and am going to order some B-12 Methylcobalamin in the next few days. Everything so far is dosed at .5ml twice daily, with 100mg per supplement. I've read through some posts on here that glucosamine is iffy so I am not including that in the mix just yet.

For insulin routine, we will likely be doing 7am and 7pm so that would be a good place to start.
 
Both MSM and glucosamine are fine. I gave an arthritis supplement to Neko that had both. Lots of people here give Cosequin for either arthritis, or I added it for my cystitis guy. I did deal with both cystitis and diabetes, but thankfully not in the same cat. Neko had enough on her plate without that too! But one of her conditions made her a ravage beast around food, and I had to strictly police feeding of her and the civvie with cystitis. It was getting so crazy I had to ask his vet for a food both could eat. She recommended raw food (to my surprise, not may vets do that!). Anyway, what he really needed was low carb, low phosphorus, with plenty of water added. Could have been raw or canned, but easier to find raw options here that are low phosphorus. And it worked for both cats so if she stole his food, no effect on her BG's. More detail on cystitis diet's on catinfo here.

It does sound like could use some insulin too. Without it, you'll have a hard time getting her to gain weight. And inflammation and no insulin and possibly not enough calories, as others have pointed out, it can be a bad combination.
 
MSM (Methylsulfonylmethane) is a compound that contains sulfur and is added in many joint supplements. It's naturally found in humans, animals and plants.

Thankfully the cystitis has not been an issue and has been under control for years. She was actually diagnosed before she even turned a year old! None of the cats have an issue with the urinary food so for now we are going to stick with that. Most of them prefer Purina (of all types) over other brands, even raw. All others they get bored with or simply don't like but they have never turned their noses up at the current food. They all get additional water since they like to have the pate more on the liquid side anyway - they are not fans of other textures even if they like the flavors.

The others are special needs as well but none require a different diet. I haven't heard back about getting a curve done so I am going to get in touch with her primary vet and see if that is something they could do instead. SpreadSheet is up, added a column to give an hour before her usual reading as we sometimes do it early.
 
SS also took longer to compile/edit than I thought. Still working on a complete form with doses for her medication and vitamin supplements as well. Did not get to reply to other questions as I'd hoped!

Her reading we 354 this morning before food and meds, even with a 1AM full feeding.
She is more active and able to walk more normally, plus is drinking more water on her own so hopefully that will help with the slight dehydration she has been experiencing. Seems far more content and alert.
 
Well hubby took her reading at 4:30 before her next meal, and her reading was 7.8 (157)?! He took it twice as he thought the meter was having an issue. Both YAY, and what is going on with this little weirdo?

I also mis-spoke in the last post, she did not get MSM added but got the B12-Methylcobalamin added to her slurry. I added the first dose to her morning meal so she could eat through the day as pleased. She usually gets it syringed orally but I was running behind. Will be checking again when I get home.
 
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Another check now that I'm home. We know she ate a bit between her previous reading. This reading is at 18.6 (374).

Is it possible there was an issue with the meter, or is such a spike common in an unregulated cat? She is still more active and alert. Her last shot of buprenorphine was this morning.
 
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She has me so confused, but she has always been an odd one so it's a pretty normal day!

Hoping we can do a min curve this weekend and get a better idea of what her numbers are like. If her pancreas is, by some miracle, starting to heal itself or responding to the vitamin slurry then starting insulin has me doubly confused and a bit worried if she can hit those kind of lows without it.

The vitamin slurry per daily dose currently consists of:

Milk Thistle (Silybum marianum) Seed Extract) - 100 mg
Turneric (Curcuma longa) Rhizome Extract (standardized to 95% Curcuminoids from 5,000 mg of Turmeric Rhizome) - 100mg
Vitamin B12 (as Methylcobalamin) - 2 mg
 
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Tinwhiskers said:
Well hubby took her reading at 4:30
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Yay, a tag team! :cool:

Glad to hear Leena's drinking more and feeling brighter in herself today. :)

Tinwhiskers said:
Well hubby took her reading at 4:30 before her next meal, and her reading was 7.8 (157)?! He took it twice as he thought the meter was having an issue. Both YAY, and what is going on with this little weirdo?
Click to expand...
Tinwhiskers said:
Is it possible there was an issue with the meter, or is such a spike common in an unregulated cat? She is still more active and alert. Her last shot of buprenorphine was this morning.
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Hubby did exactly the right thing by testing again as soon as he saw an unexpected reading (sometimes you do get duff test strips). If the readings were very comparable then it's
most unlikely the lower BG reading was due to a fault with the glucometer.

Couple of things that could have potentially influenced the lower reading:

1. Uptick in activity today.

2. Better hydration (blood glucose concentration would be more dilute.

3. Maybe less pain today? (Might be worth recording how many hours after the bupe dose was administered that the lower range reading was taken in the Remarks section of the spreadsheet.)

4. Sometimes a pancreas can sputter a bit and produce a little more insulin than normal. A healthy pancreas is supposed to send out a pulse of insulin at mealtimes to handle the uptick in BG levels due to the ingested food. If the pancreas is a bit 'sputtery' and intermittently starts producing more insulin, often eating is what triggers the intermittent spikes in insulin output (hence why I suggested doing a test a couple of hours after Leena eats a meal when you run your pre-insulin mini-curve).


Mogs
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Tinwhiskers said:
starting insulin has me doubly confused and a bit worried if she can hit those kind of lows without it.
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^This is why home testing is so important.^

Cats can throw curve balls like that when on insulin but testing and tracking BG levels to determine dosing helps you to learn your kitty's response pattern. While there are never 100% guarantees that a cat won't throw a wobbly on a particular cycle with a dose that normally keeps it in safe numbers, by starting at a low insulin dose, 'learning' your cat's response and gradually working your way up the dosing scale as needed then that massively reduces the risk of hypos. As you learn more and gather more data you'll be able to use your spreadsheet data to help you spot early warning signs that a cycle is likely to be particularly active. But there are also pyjama parties where you just have to apply tape to your eyelids to hold them up and sit with your baby, testing and feeding until she's safely out of any unexpected low.


Mogs
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Thanks @Critter Mom, was hoping this would be something we should look for when we do the mini-curve. Wanted to make sure if this reading was indeed accurate then it is something we should try and pin-point more.

Since she is off the bupe (she had her final dose this morning @ 7am. Prescription is done and we will see if her knee will heal/scar over without surgery. Will note in remarks.) it will be interesting to see if the levels start lowering on their own like they have the past few days, or if they will elevate to the 400 range again.

Is there an 'average' or 'healthy' range for what a normal pancreas would spike to in cats? Duration? Wondering if we can not only monitor her BG for possible diabetes but also to see if there is any sign of her pancreas healing too (minus ultrasounds more often).
 
Been a few days since she has been completely off the bupe, and her BG is slightly lowered from her previous numbers even with increased mobility.

Ran out of strips on Sat as he forgot to tell me he'd used multiple strips to try and get a reading, but fussy girl wasn't having it. So nothing for that day. Hoping we can see those numbers lower even more if inflammation/detox slurry is having a positive effect.
Still no word from the second vet on getting a curve or ultrasound. Called yet again and the tech made doubly sure a note was left on her patient portal. The run around is very frustrating and getting old fast.
 
Tinwhiskers said:
Is there an 'average' or 'healthy' range for what a normal pancreas would spike to in cats?
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Sorry for taking so long to reply (I'm not doing too well at the moment).

I used an Alphatrak meter. My vet gave me the reference range of 3.9 - 8.3 mmol/L as the normal range for blood glucose levels in cats. (Multiply the mmol values by 18 for the US mg/dL equivalents.)

If the pancreas is producing pulses of insulin in response to ingestion of food then you might see a rise over the first 1-2 hours after the feed and it would drop again after that.

If BGs dip after eating but rise significantly after a longer period between feeds that may be a possible indication that the pancreas is not secreting enough basal insulin between meals to regulate sugars released from the liver during that time.

WRT degree and severity of any pancreatic inflammation that may be present, the only way I know of to gauge that is by running a Spec fPL test. That said, there is a strong likelihood that a flare will elevate BG levels.

Sorry the vets are messing you around. Hope they get back to you soon.


Mogs
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