The information contained in this sticky is provided for educational purposes only and is not intended to replace veterinary advice. The intention of this sticky is to open doors to understanding about the specific medical condition and allow for educated and on-going discussion with your vet.

 

Pancreatitis 101

 

Below is information to help caregivers to understand what pancreatitis is and what seems to work best as far as treating this condition. Hopefully this will provide some information to discuss with your vet to confirm a diagnosis. Even more so, it is hoped that this information will give you some steps to take to try to avoid pancreatitis altogether.

Dr. Hodgkins states in her book Your Cat, Secrets to a Longer, Stronger Life, cats with FD typically have at least low-grade pancreatitis as well. As a result, when a cat comes along that is not achieving expected results with insulin, initial thoughts should turn to the likelihood of pancreatitis. It is a very common disease, far more than has been believed in the past. According to Idexx Labs, pancreatitis is suspected to be one of the main causes of poor control in FD cats. To date, studies have only been completed at autopsy, however it is claimed at autopsy, 50% of felines without FD have some grade of pancreatitis.

A CBC (complete blood count) cannot conclusively confirm pancreatitis, nor can it be conclusively confirmed by ultrasound, or by a physical exam. If the results of the CBC show elevated cholesterol and liver values in a cat, and/or an ultrasound shows inflammation or “spots” in the area, and/or a physical exam indicates some swelling or tenderness in the abdomen, it is a wise decision to ask for a pancreatitis test. Most low carb, wet fed cats will have a somewhat elevated cholesterol level, and most vets, knowing the cat is all wet fed, are not usually concerned by elevated cholesterol levels in cats due to the higher fat content in food. That said, very high cholesterol levels can lead to pancreatitis and sometimes lead to other issues such as gallstones.

If your cat is not responding to insulin, even when increasing doses, the test for pancreatitis would be a worthwhile spend to confirm or deny diagnosis.  The only reliable test available at this time to measure serum feline pancreatic lipase immuno-reactivity level is the
Spec fPL1 test by Idexx (see the side bar on the Idexx page for more information).  The test costs anywhere from $50.00 to $150.00 depending where you live.   Some vets choose to use the Snap fPL1 - however, this test does not give more than a yes or no that your cat has pancreatitis.  The only test that is definitive when it comes to determining the severity of pancreatis is the Spec fPL1.  We recommend insisting on the Spec fPL1 - as the severity of the disease is beneficial to know when attempting to reverse pancreatitis.

Because this test is relatively new, and because this disease is not yet well understood by most vets (who still believe that CBC, US and/or physical exam are sufficient for a diagnosis), if your cat isn’t responding to insulin as expected, liver and/or cholesterol levels are high end normal or above, and pancreatitis is remotely suspected, standing firm with your vet may be called for to get the Spec fPL1 test if you want a conclusive diagnosis that identifies severity.  

Please note - for the best results, when having a Spec fPL1 done for your cat, a fast for a minimum of 6 to 12 hours is recommended prior to the blood draw taking place.  Taking some food to the vet clinic to give right after blood is drawn is a good idea; many inappetant cats will be hungry by this time and will be more accepting of food.  The vet clinic will be able to provide a feeding syringe if necessary, or feeding can be attempted by hand.

What is Pancreatitis?
 
The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help our cats digest fats, proteins and carbs in food. The pancreas also releases insulin and glucagon into the blood – these hormones help the body use the glucose it takes from food for energy. Typically, digestive enzymes don’t become active until they land in the small intestine when digestion of food starts. But, when these enzymes become active inside the pancreas or at the duct area, they can start to “digest” the pancreas/duct, causing inflammation and even permanent damage.

There are two main forms of pancreatitis - Acute pancreatitis and Chronic pancreatitis.

The low level form of pancreatitis Dr. H refers to in her book is typically of the chronic kind. It hides itself well, lurking below the surface, doing its damage undetected. Chronic pancreatitis is no less dangerous than Acute pancreatitis if left untreated over the long term. It is generally believed that chronic pancreatitis does not ever resolve. Recent studies indicate that supplementation of taurine and sylmarin aid in the regeneration of both the liver and the pancreas. With long-term supplementation, pancreatitis usually can be well managed depending on the severity and how quickly it is caught.

Because cats hide pain so well, the signs that our cats aren’t feeling well are usually so subtle they are missed by even the most attentive of owners. Something as subtle as your cat repeatedly seeking out cool places to rest their tummies could be a clue that chronic pancreatitis is brewing in the background, as pancreatitis can cause abdominal pain. In humans, the pain is described as being “similar” to extreme heartburn, sometimes coming and going. The pain may get worse when eating or drinking, and can become consistent and disabling. In certain cases, abdominal pain actually goes away as the disease progresses, likely because the pancreas stops making digestive enzymes. Other common signs of pancreatitis are vomiting, nausea, weight loss (even if eating habits are normal), fatty stools, and lethargy.

Acute pancreatitis - as its name portrays, the “attack” (and it is always an attack) is acute – coming on very suddenly and severely. A cat that was “fine” at lunch, eating – playing – alert…could become a limp-anorexic-unresponsive kitty by dinnertime. In the event of an acute pancreatitis attack, it is imperative to respond immediately to the crisis. Aggressive insulin treatment if needed, syringe feeding (or insertion of a feeding tube), subcutaneous fluid administration, and pain management are called for right away. An acute pancreatitis attack can take anywhere from one to two weeks (or longer) to resolve to the point where a cat is able to eat on its own. If immediate action is not taken, acute pancreatitis attacks can be fatal.

Both forms of pancreatitis can cause serious complications for our cats…. some more severe than others. Malabsorption of food, internal bleeding, damage to tissue, infection, cysts, fluid accumulation, enzymes and toxins entering the bloodstream, damage to the heart, lungs, kidneys, and/or other organs may occur if left untreated. It is suspected that pancreatitis in cats may also cause FD. Diabetes develops because insulin-producing cells (the islet cells) of the pancreas become damaged.

For more information, here is a link to Idexx’s
 Roundtable on Pancreatitis.

What causes pancreatitis?

In humans, pancreatitis is caused by alcohol abuse, the pancreatic duct becoming blocked or narrowed; high levels of calcium, high levels of blood fats, autoimmune conditions, and some drugs to mention a few causes. It can also be idiopathic (unknown cause), or hereditary. Other than alcohol abuse, it makes sense that any of the things that cause pancreatitis in humans can cause it in our feline friends.

So what to do?

Traditional vet therapies for pancreatitis include the withholding of food for 24-48 hours. This has been standard practice when treating small dogs, but this is not the right way to go for cats. Particularly with cats on insulin, they need their food to keep their strength up. An all wet diet, low in fiber, and as low in fat as possible is better indicated to help ease the load on the pancreas.

In addition, some vets will include the use of antibiotics to treat pancreatitis, but they aren't always necessary, and typically don't work anyways - usually resulting in making your cat feel more nauseous than they already to.  Antibiotics are indicated in the event of cholangitis (or triad disease) - where a bacterial infection has developed in conjunction with pancreatitis.

If your cat is anorexic and syringe feeding is not possible, a feeding tube (inserted by the vet) is highly recommended. In the TR College of Knowledge, there is a recipe for the Sick Mix, which is recommended when the need for syringe feeding arises. Supplements (other than Slippery Elm) can be mixed into the Sick Mix formula.

Any owner of an FD cat would be well advised to start their cat on a supplementation program right after FD diagnosis to try to avoid the development of pancreatitis altogether.

Supplements

As previously mentioned, supplements are proving to have a strong place when it comes to pancreatitis. The standard rule of thumb for dosage when it comes to cat is 1/6th (for larger cats) to 1/10th (for smaller cats) of a human dose. It is always a good idea to start out with a lower than recommended dose and work your way up to a suitable amount for your cat. Some supplements have a very strong taste or smell and are not always well accepted at first. In addition, it is best to start supplementation one supplement at a time. There is no way to know how your individual cat will accept the individual supplements, or how they will affect their BG. By taking it slow but steady, if there are any challenges with any supplement, you will have a much better idea of which one might be causing any problems for your cat.

Sylmarin is a wonderful liver support, also recommended for FD cats by Dr. H in her book. Recent studies have shown that sylmarin works to regenerate liver cells. SamE is also excellent support for both liver and pancreas. Denemarin or Sam-E 100 both contain both Sam-E and Sylmarin. Denosyl is plain Sam-E, while Milk Thistle Tincture is just sylmarin. There is also plain Sam-E for humans on the market, but the tablets are usually too large for cats. SamE has an enteric coatiing and must be given on an empty stomach. 

Denemarin and Denosyl are both vet products that come as enteric coated tablets which cannot be broken. They must dissolve in the gut and therefore must be given on an empty stomach.

Milk thistle – the active ingredient in milk thistle is sylmarin. It comes in powder and liquid form. The challenge with powder forms is that rice flour and other carbs not suitable for FD cats are usually added. If possible, liquid milk thistle (tincture) is a better choice. Look for the highest amounts of sylmarin extract you can find (70% or more), and the lowest count of ethanol (alcohol) – ideally under 5%.

Choose only one of the above mentioned supplements, not all of them.  Milk Thistle (sylmarin) can be given along with Denemarin.


Taurine – preliminary recent studies indicate that taurine is also capable of regenerating cells of the liver, as well as pancreatic cells. This is exciting news! The maximum dose of taurine is up to 500mg per day.

L-carnitine – this amino acid helps the system break down fats to process them through the system. Acytel Carnitine or D-carnitine are NOT at all suitable for cats. You will want to make sure you get the purest form of L-Carnitine you can find. Nature’s Way has a suitable L-Carnitine product for cats, available through Vitacost at a very reasonable price. Daily dose 250mg. Here’s a great article on the benefits of LCarnitine, follow the links to “learn more”…the sidebars have great info on the use of LCarnitine in cats as well.

In humans, the use of L Carnitine is not recommended for those who have seizures, are using blood thinners, or have hypothyroidism. Similar caution for use in cats is recommended.

Agaricus Blazeii mushrooms – available in capsule form, and also available in liquid form (called Super Bio liquid from Atlas World). Dr. H highly recommends all FD cats get this supplement. It is an overall immune system support. In fact, her instructions to me were “give your cat a quarter capsule a day and take the rest yourself”.

Acidophilus – this probiotic is very helpful when it comes to malabsorption issues, which are very common for cats with pancreatitis. Daily recommended dose is ¼ capsule a day. Make sure that there are no sugars or FOS in any probiotic you choose. While the argument is that FOS does not cause resistant BG or other health issues in humans, experience on forum so far indicates FOS does cause problems for our cats. Country Life makes a dairy free version with no sugars, suitable for FD cats.

Slippery Elm Bark Powder – is very helpful when it comes to malabsorption issues.  The standard dose is 1/8 to ¼ tsp once a day. This supplement must not be given with any other supplements or medications as it renders them useless. It is best to give Slippery Elm two hours apart from any other supplementation/medication.

Vitamin B-Complex – this supplement is beneficial in times of stress. In the event of an attack of acute pancreatitis, add this supplement to food when syringe feeding. Look for B Complex which has a low amount of inositol and a good amount of folic acid.

Pancreatic enzymes are also useful when dealing with pancreatitis. Speak to your vet before adding pancreatic enzymes to your supplement regime to deal with pancreatitis.  Typically pancreatic enzymes are used when there are accompanying gastro-intestinal troubles. Pancreatic enzymes come in two forms - vegetable matter or animal matter.  For obvious reasons, pancreatic enzymes made from animal matter are better for felines. Immoplex Raw Glandular enzymes are available through DCC's Affiliate Partner Herbs Pro.  Source Natural is also an acceptable brand for FD kitties. When using pancreatic enzymes for a cat, it is important to make certain they are animal and not plant based.

Other steps to take….

Adding fluids, either subcutaneous fluids with electrolytes, or adding water or plain broth (directly to food or by syringe) is helpful. Dehydration is very common when dealing with pancreatitis, especially the acute form. Home made chicken broth, cooled with the fat skimmed off is usually better received than plain water and can be added to food or syringe fed with a baby dropper.

Pepcid AC (must be AC - active ingredient famotadine) is also very helpful when dealing with a cat with pancreatitis. Ideally given 20-30 minutes before feeding, the dose is 1/4 tablet twice a day (BID).

For pain management, ¼ of a baby aspirin only can be given for a day or two. Aspirin can be toxic in cats, so this is definitely not a suitable pain management therapy on an ongoing basis. PLEASE CONSULT YOUR VET BEFORE GIVING ASPIRIN TO YOUR CAT!

The treatment methods are the same for both Chronic and Acute pancreatitis – and the supplements are beneficial even if your cat doesn’t have pancreatitis as FD affects many organs. In fact, considering that recent studies prove even cats without FD contract pancreatitis, a reduced regime of supplementation as a preventative may be a good thing for your cats that are not diabetic.  For further (more in depth) assistance please post on Talking TR forum.




© Diabetic Cat Care - Updated November 2013