My very very sick cat/pancreatitis

I really need some input. My 8 year old domestic short haired cat has developed pancreatitis, with hard stool becoming obstipated. He quit eating and drinking 10 days ago, 3 trips to the vet to get if fluids, steroids, anti nausea meds, vomiting was severe. I got him to eat some canned food, he really loves dry. 2 days ago at last trip to vets and severely dehydrated again, he was found to have a blood glucose of 395, so now I am dealing with a diabetic cat????? He is not vomiting now but can't get him to drink water, I have tried everything, he did lick a little broth today. Not only are my funds limited I work so many hours, hard to stay with him. I have him locked in my bedroom with me away from other cats. My vet says she hates to give up on this cat yet. I watch him suffer and he looks at me to fix this. I guess I understand if his pancreas is not working anymore, he will be diabetic, 2 shots a day!!! And not sure this would fix the problem. I can't see why diabetes would make him not drink??? Plus his stool becomes like rock inside him, maybe from not drinking. Does anyone have any advice, knowledge, or anything they can tell me that would help. At this point I can't let my most fun active cate suffer much longer, unless there is a miracle. It's hard to see the life leave his eyes like this.
Hoping someone reads this and has advice for me and my little Monkey Boy.

Cindy

How much food has he had in the last 10 days? Not eating is extremely dangerous for a cat. It only takes a few days to cause liver problems. And if he's constipated, are they doing anything to help with that? It sounds like he definitely needs a lot more fluids.

Have you considered getting a second opinion from another vet? If they are not able to find out the problem here.

Hoping someone more familiar with pancreatitis is able to offer some more insight on this.

Is he getting anything for pain?  Unfortunately there is no magic fix for pancreatitis but pain control is necessary.  Controlling pain may help with the anorexia.  He may not actually be diabetic.  The high blood sugar could be a temporary thing because of the inflammation in the pancreas.  Kitties can also have a transient high blood sugar reading because of stress.  One of my kitties had a high reading when she was sick.   The vet had a sample sent out that gave a better reading as far as blood sugar readings over a period of time before the blood was drawn and it came back normal.

Thank you for responding, he eats about 5 kibbles every couple hours, he has eaten some canned food. I really am worried about the fluid intake, he is just not drinking, I added water to the canned food and he would not eat it at all then. I am laying here with him thinking about putting another type of canned food out. I can't do anything real high in fat because of the pancreas and since I learned about diabetes yesterday, I was like "really??" This poor thing. I have other cats here also. This is really very sad and I really can't afford anymore expensive tests

I'm so sorry to hear your kitty is so sick.  Your kitty needs to eat, that is critical.  Were you given something like Cerenia for anti-nausea and Buprenorphine for pain?  Inappetance is often caused by nausea and pain. SubQ fluids will help as well.  My Tiger had an acute attack of pancreatitis, which lead to chronic pancreatitis; plus she was already diabetic.  But she did recover from that first attack by being hospitalized for 2 days, then with continuing supportive treatment at home. I did have to search for a new diabetic friendly canned food because she developed an aversion to her Purina DM that she was eating.  She did learn to love Weruva canned Fowl Ball and Pumpkin Lickin Chicken while she was sick. And I agree, the pain of her illness can often raise the Blood Glucose, she may not be diabetic at this point.

Some info that you might find helpful:

http://www.idexx.es/pdf/es_es/small...pec-fpl-treatment-for-feline-pancreatitis.pdf

Assist feeding a cat:

You mention that your cat has gotten fluids at the vet. Do you know how much fluids? If the vet is giving him his daily allotment (typically 100-120 mL) then he likely will not drink water for a day or two.

As for the diabetes, I personally wouldn't really put much stock in that at the moment since being sick can alter these results. Did your vet think that his glucose levels were actually realistic considering the pancreatitis and dehydration?

Also, have you tried offering kitty some baby food? I use Gerber brand turkey&gravy or chicken&gravy. You can use another brand, just make sure that there isn't any garlic or onion in the ingredients. Should just be meat, water and maybe some cornstarch as a thickener.

If he won't willingly eat, you can try syringe feeding him.

You may need to discuss giving your cat SubQ fluids at home with your vet and possibly inserting a feeding tube if kitty really isn't eating much at all and syringe feeding doesn't work.

I also agree about using Cerenia and Buprenex. A low dose of metronidazole can also be used.

Thank you, my boy has gotten 100ml IV when he goes to the vet, he was licking the water a little but apparently he is not getting enough. Glad you said that about the diabetes, actually my vet is going to redraw blood next week to check the sugar, she must think like you do. I have offered baby food, he won't touch it. Actually I just thought of something I know he loves but not sure how good it is for him, he loves yogurt, maybe I can do low fat. Vet told me to try to keep it low fat for the pancreas. Thank you, it makes me feel better and not so helpless when I hear ideas.

Dear Cindy,

So sorry to hear about your poor kitty and your strains caring for him. 

I'm sorry I can not help much. Just can give some thoughts and "human" relation. 

It was more than a decade ago, but I had a bad case of pancreatitis, didn't know if I would live much longer. 

I could not eat or drink anything (but was restricted from doing so because my pancreas could not handle it, until gradually, and had a PICC line and food tube put in). 

For my beloved cat family members, I will put in all of my savings for them if needed (and have done my best over the many years with them having other both acute and chronic illnesses.

- So for drinks, there may be several flavors that he loves (in sauce or even treats you can find to FLAVOR the water, it could lour him to drink more). 

- Milk flavored if safe to have (i.e. even perhaps hemp or almond milk if safer?)

- Saucy wet food with lots of juice could be important to sneak the fluids in. 

- FOOD: One of my cats is so picky and prefers dry food much more than canned, but we do vary foods a lot, and she almost always likes the pouches of wet food. We get all natural cat food brands only, however, I remember over years, our friends at the vet clinic said that usually when a cat is sick and just really NEEDS to have some food, they often go to one of the less healthy ones: FANCY FEAST which they almost always like. 

I am still alive, and I hope that your kitty will stay strong. He is still young too, so sending over warm wishes!

Thank you for your advice and help, everyone!!!! My Monkey Boy did survive his pancreatitis, he is now on insulin for diabetes, major adjustment, not really the same cat, but slowly getting better, eating well. His mom and sister have not quite accepted him back yet. He has been on insulin 2 x daily for a week now, I just realized this will consume my life, lol I will race home to give shot and feed canned food. His glucose was 390, will have it rechecked next week, hopefully its better

Soo happy for this update!! Wishing you some uneventful weeks and months to come!

Cindy Miller said:

Thank you for your advice and help, everyone!!!! My Monkey Boy did survive his pancreatitis, he is now on insulin for diabetes, major adjustment, not really the same cat, but slowly getting better, eating well. His mom and sister have not quite accepted him back yet. He has been on insulin 2 x daily for a week now, I just realized this will consume my life, lol I will race home to give shot and feed canned food. His glucose was 390, will have it rechecked next week, hopefully its better

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So glad to hear your update on Monkey Boy- Sending him the strongest continuing healing vines for a complete recover!

Which insulin are you using? Are you hometesting? So much less stressful than a curve run at the vet's office and one sure way to keep kitty safe when giving insulin.   Feline Diabetes Membership Board was so helpful for me when my girl was first diagnosed - wonderful experienced people that can give support or answer any questions, 24/7.  My vet and vet tech taught me how to home test, and the rest I learned from the wonderful helpers at the FDMB forum.

http://www.felinediabetes.com/FDMB/

You have probably already seen this- Dr. Lisa Pierson created this Food Chart which you might find helpful:

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

I am only into 10 days of insulin injections, this is a task in itself, I will not poke his ear to test glucose. I really don't want him afraid. I am using novulin insulin. I don't know what his levels are at but he is better then he was. I have appt on Friday to see the vet and find out where glucose levels are at.
Thank you so much, I will check out info you sent, nice to know there is help

Cindy Miller said:

I really need some input. My 8 year old domestic short haired cat has developed pancreatitis, with hard stool becoming obstipated. He quit eating and drinking 10 days ago, 3 trips to the vet to get if fluids, steroids, anti nausea meds, vomiting was severe. I got him to eat some canned food, he really loves dry. 2 days ago at last trip to vets and severely dehydrated again, he was found to have a blood glucose of 395, so now I am dealing with a diabetic cat?????

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I'm just seeing this thread now.  An eleveated bood glucose level is not unusual fro a sick stressed out cat. Do you know if the vet did a quick blood glucose test with a meter or did they do a fructosamine test along with other bloodwork? A quick test ony tells what the blood glucose levels is at that very moment. Many cats have elevated levels because they are so stressed out just being at the vet's office. The fructosamine tells the average blood glucose levels over the past few weeks, similar to the AC1 in Human diabetics.

Novolin insulin isn't the best one to use. Lantus, Levemir, and ProZinc are the preferred insulins to use with cat. Discuss these with your vet. BCP PZI is also an option.

Home testing blood glucose is a must to track your cat's daily levels and to know if he's at a safe enough level for insulin to be given. You do not want to give insulin if your cat is at a normal level, roughly 60 to 150 mg/dl. Doing so will result in the blood glucose level crashing too low which results in hypoglycemia. Have honey or corn syrup and junky gravy canned food on hand to use for a minor hypoglycemic episode. Severe symptoms (seizures, coma, etc)  needs immediate vet treatment. There is a bit of a learning curve to home test and some cats don't like it at first but once you get the hang of it, it's really easy to do. When I had a diabetic cat I was able to test him and give insulin in less than a minute. Testing alone takes 30 seconds max. Poking the ear to get a blood drop isn't hurtful and doesn't harm the cat in any way. Cats do pick up on your emotions so be calm while you test.

The FelineDiabetes.com message can better provide help and support for you and your diabetic cat. I highly recommend at least browsing the boards over there and read the info stickies at the top of each board.

Hi, cindy miller , if that's your Monkey Boy in your avatar photo, he's very handsome! I can tell how much you love and care for him!
:heart3:

So glad to hear that your cat pulled out of the bout of pancreatitis he experienced; it's a very difficult and painful thing for a kitty to go through. I echo the words of several here, that some pain meds (like buprenorphine) and subQ fluids are ever so helpful when a kitty goes through this. When your funds and time spent at home with him have to be limited, the choices of care and support he'll most need are best discussed with your vet, in order to figure out what will make him most comfortable. It sounds like your vet determined that Monkey Boy had diabetes, and probably (?) tested the blood glucose to figure out what dosage of insulin to try with him? And that you have another vet visit at the end of this week to determine his progress on that dose? LTS3 brings up the fructosamine test, and other bloodwork, which is likely what your vet may have used to help determine that he needed insulin.

If you do find that the insulin is needed long-term, and he is doing much better in the coming months/weeks, it will really help to test his BG levels at home, via pricking the ear. It seems scary at first, and stressful (for the both of you!) but once you get the hang of it, it becomes 2nd nature.

What really helps is (1) having the vet or a vet tech show you in person how to do this, (2) watching videos of experienced people doing the ear pricking tests, and (3) getting very familiar with your kitty's ears and knowing where the best veins are for you to most easily get a drop of blood from him to test.

It's better to see the veins when you test by having the cat's ear back-lit, but once you get familiar with the approx location of the veins, it gets easier to do this with less lighting.

My own experience with BG testing on a cat's ear was with my last cat, who had diabetes for the last 4 years of her life. I tended to prick the outer vein along the upper, outer edge of her ear (near the top portion of the ear). This is the vein that seems to run around near the outer edges of the ear. If you warm the ear just slightly before you test, the drop of blood will flow quicker and the testing will go easier for you. Always make sure that your hands and your cat's ear are clean. (I can mention more but it really is best if you have your vet or vet tech walk you through this, not me! They will have their own helpful hints and suggestions too.)

I found some helpful photos of my current kitten's ear(s) in various lighting situations, so you can get a sense of what's going on with a cat's ear veins. You could spend some time with Monkey Bear's ears and get to know his ears really good -- so that if you ever decide to test his blood glucose at home, it might be a bit less stressful for you at the start. For me, it helped to have a routine when doing the ear testing, so that the cat knows what is coming his/her way by your actions. And I always gave a little treat after the test, so that the cat looked forward to getting a tasty treat at the end of it all.

Good shot of Milly's ears in the sun; you can really see the veins:



Here are a few shots of one ear in shadow, one in the sun:




In the following pics, you can see what your faced with, when there is no back lighting to view the ear veins -- this is when it helps knowing your cat's ears, and approx where location of the vein is where you need to prick for a blood test. If you look hard enough, you can still find the vein by seeing that it is a little raised up on the ear itself where the vein is running, like a little upraised line:


Most likely I've bored everyone with all of these ear shots! And you may not even decide to do the testing yourself at home. But maybe this will help someone in the future if they do decide to do ear prick testing at home. It's all about being calm (for the cat and for you!), knowing the cat's ears enough so that you don't have to try too many times to get a good drop of blood, etc. As LTS3 said, it does get pretty easy to do, with practice.

That is soooo nice that you showed me all this. Thi cat is the type that no one can get near him, if you hurt him, he won't be anywhere in sight. I am the only one that can touch him, so giving him the shot is tricky but doing OK. The vet can't even show me how to do anything on my cat, he has to be sedated to be examined. I can do alot with him myself but he has limits.
Also I was told that insulin like lantus, levemir, and trujoly, should not be used in cats. Once a day insulin does not keep them regulated as well.
We will have this discussion on Friday, after she sedated to draw blood. I might say he is also not my only cat, might be different if he was. I rescued his mom, and have his sister and mom. They have not totally excepted him back into the family.
This seems to be so much drama, when I was told, its on cats are easy, nothing will be like that poodle you owned!!!
So I will do my best to research and keep my Monkey Boy happy and healthy as long as possible.

Cindy Miller said:

That is soooo nice that you showed me all this. Thi cat is the type that no one can get near him, if you hurt him, he won't be anywhere in sight. I am the only one that can touch him, so giving him the shot is tricky but doing OK. The vet can't even show me how to do anything on my cat, he has to be sedated to be examined. I can do alot with him myself but he has limits.

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That is too bad! This makes it very difficult, doesn't it!

Cindy Miller said:

Also I was told that insulin like lantus, levemir, and trujoly, should not be used in cats. Once a day insulin does not keep them regulated as well.

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Lantus is given BID (twice a day). My last cat (the one who developed diabetes) was on Lantus twice a day for 4 years. She got pancreatitis in her last 6 months (had 3 different bouts of pancreatitis -- it was rough). By the way, [many] steroids raise blood glucose levels. My cat could never be on steroids when she got pancreatitis, as it would complicate her diabetes.

Has your vet had a lot of experience with feline diabetes? Some vets have a bit less experience than others, that's why I ask.

Cindy Miller said:

We will have this discussion on Friday, after she sedated to draw blood. I might say he is also not my only cat, might be different if he was. I rescued his mom, and have his sister and mom. They have not totally excepted him back into the family.
This seems to be so much drama, when I was told, its on cats are easy, nothing will be like that poodle you owned!!!
So I will do my best to research and keep my Monkey Boy happy and healthy as long as possible.

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:heart4:

Cindy Miller said:

Also I was told that insulin like lantus, levemir, and trujoly, should not be used in cats. Once a day insulin does not keep them regulated as well.
 

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Your vet doesn't seem up to date with current diabetes treatment, which is not uncommon. Definitely check out FelineDiabetes.com to read up on the current ways of managing diabetes and discuss with your vet. IMO, it's important to be proactive in the cat's care especially if the cat has a medical condition  Sometimes you find information that the vet has never heard about and who might be willing to give it a try. Don't rely on the vet to know everything just because he / she has a DVM degree and is supposed to be an expert.

Lantus and Levemir work very well for cats. There is a well published Lantus dosing protocol for cats: http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf Levemir is dosed in a very similar way. A copy of the published study article is here if you want to show it to your vet: http://www.intervisievoordierenartsen.nl/uploads/Groep26/20-03-2013/Glarcine 2.pdf

Lantus and Levemir are dosed twice a day, never once a day. I am not familiar with Trujoy insulin. It must be a new one that came out after my diabetic cat passed away. Lantus and Levemir are insulins for Human use, you buy these at the Human pharmacy with a prescription. They are available as a 10 ml bottle or in insulin pen form. The pens are preferred by many since a pack of five 3 ml pens lasts at least 5 months while the 10 ml bottle tends to lose effectiveness after a month or so.

It's possible to get a difficult cat to hold still for a quick blood glucose test. If the cat can hold more or less still for insulin, he can hold still just a bit longer for a test Try holding an ear in your hand for a few seconds before you give insulin. Reward with a diabetic friendly treat. Freeze dried meat treats are great such as PureBites. When you do test, you're not aiming directly for the ear vein, just the space between the vein and the edge of the ear. if you accidentally hit the vein and get a gusher, no big deal. Get some blood onto the test strip and then hold a tissue over the ear to help stop the bleeding. Some people test on a paw pad instead of an ear.

Wow, you are really giving me lots of info. Also after reading your post, the least I can do is try poking the ear. This is all new to me and I hurt him a little with insulin shot, ddduuhhh.
As far as lantus and levemir ( actually same drug) as is trujoli. I deal with human diabetics and all those insulin are qd, long acting insulins, very rare case would be a bid dosing. I am thrilled you have given me so much info and the courage to poke his ear.
When I go Friday to the vet I am armed with lots of info now. I must learn to poke his ear the once a week vet visit will not work, he gets rejected worse when he gets home, smell of clinic is all over him. He stresses so bad, terrified the pancreatitis will come back, unless he actually never recovered. Hard to tell this is such a different cat now. I feel sad for him that his mom rejects him.
Thank you so much for your encouragement!!!

It's understandable to be overwhelmed with everything right now This might help put you at ease: http://www.felinediabetes.com/dear-mom.htm

My diabetic was a pincushion I tested his blood glucose levels several times daily. He was a pretty laid back cat so I had no problem with poking him. I could even test him while he was sleeping. I kept a log of all his blood glucose levels and shared with the vet who used the information to determine dosage changes. There's a great spreadsheet template on the FDMB board that you can use.

Testing at home is much less stressful than lugging the cat to the vet every week and much less expensive. Most people use a Human diabetic blood glucose meter. Others prefer to use a pet specific blood glucose meter. The only problem with a pet meter is that you can't run out to a store to buy test strips so you have to check your supply often and order more before you're down to the last test strip. I used the basic AccuChek Aviva. It was easy to use, only needed a tiny drop of blood, and gave a reading in 3 seconds. I previously used the AccuChek Advantage but it needed a larger drop of blood which was often hard to get and took forever to give a reading.

Some people with really fractious cats can only do urine glucose testing which isn't all that accurate since glucose builds up in the urine until the cat uses the litter box so the level will always read high.

It's common for diabetic cats to also have pancreatitis. If you scroll down this thread a bit there is info on how to manage CP in a dibabetic cat. Some people feel that too much fat in the diet can cause a CP flare up. A low fat  / low carb preferably canned food seems to work best for diabetic cats prone to CP.